Individual
BRIAN S DODD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA331
ID
363AS0400X
Surgical Physician Assistant
Primary
0010-04342
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010030444
REGENCE BLUE SHIELD
ID
01
—
000010162910
REGENCE BLUE SHIELD
—
01
—
029674
WA DEPARTMENT OF LABOR
WA
01
—
194498
OMAP
OR
05
—
806341400
—
ID
01
—
8K248
BLUE CROSS OF IDAHO GROUP
ID
01
—
PAF45
BLUE CROSS OF IDAHO
—
01
—
PAMD9
BLUE CROSS OF IDAHO
ID
Enumeration date
08/19/2006
Last updated
04/29/2016
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