Individual
MARYELLEN LEANN DODD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6406 N SANTA FE AVE STE A, OKLAHOMA CITY, OK 73116-9117
(405) 840-3793
(405) 840-3794
Mailing address
6406 N SANTA FE AVE STE A, OKLAHOMA CITY, OK 73116-9117
(405) 840-3793
(405) 840-3794
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
24368
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054978900
—
MN
05
—
200081020A
—
OK
Enumeration date
12/29/2005
Last updated
07/15/2022
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