Individual
DIANE DODGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
315 E ASH ST, PERRY, FL 32347-2029
(850) 584-3278
(850) 584-8171
Mailing address
330 BISHOP BLVD, PERRY, FL 32347-3618
(850) 584-3278
(850) 584-8171
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME99971
FL
261QP2300X
Primary Care Clinic/Center
Primary
ME99971
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
279528100
—
FL
Enumeration date
10/12/2005
Last updated
03/17/2017
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