Organization
JEFFREY DODD MD A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA SMALL (MANAGER)
(530) 587-7461
Entity
Organization
Contact information
Practice address
10051 LAKE AVE, SUITE 3, TRUCKEE, CA 96161-4825
(530) 587-7461
(530) 587-1149
Mailing address
10051 LAKE AVE, SUITE 3, TRUCKEE, CA 96161-4825
(530) 587-7461
(530) 587-1149
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A81163
CA
332B00000X
Durable Medical Equipment & Medical Supplies
A81163
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A811630
—
CA
01
—
1699966358
BLUE CROSS
—
01
—
P00089905
RAILROAD MEDICARE
—
Enumeration date
08/07/2007
Last updated
05/13/2009
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