Individual
DR. JACK M DODSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 635-5264
(573) 634-7423
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 635-5264
(573) 636-5881
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
101346
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203375613
—
MO
Enumeration date
02/01/2006
Last updated
08/14/2015
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