1538165113 NPI number — DR. PAUL MELTON DODD III MD

Table of content: DR. PAUL MELTON DODD III MD (NPI 1538165113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538165113 NPI number — DR. PAUL MELTON DODD III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DODD
Provider First Name:
PAUL
Provider Middle Name:
MELTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538165113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 102222
Provider Second Line Business Mailing Address:
ATTN: CREDENTIALING DEPT
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30368-2222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-274-8200
Provider Business Mailing Address Fax Number:
239-278-3350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 CLYDE MORRIS BLVD STE 450
Provider Second Line Business Practice Location Address:
FLORIDA CANCER SPECIALISTS P L
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32174-8179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-673-2442
Provider Business Practice Location Address Fax Number:
386-673-4884
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0000X , with the licence number:  ME78210 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: ME78210 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 256247200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 46865 . This is a "BCBSF PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".




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