Provider Demographics
NPI:1548267073
Name:DODSON, MARTHA A (DO)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:A
Last Name:DODSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4316 OKEEFE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1320
Mailing Address - Country:US
Mailing Address - Phone:915-637-4787
Mailing Address - Fax:
Practice Address - Street 1:4316 OKEEFE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1320
Practice Address - Country:US
Practice Address - Phone:915-637-4787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6406207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1175119Medicare ID - Type UnspecifiedINDIVIDUAL
TNG40620Medicare UPIN
TX8A2678Medicare ID - Type UnspecifiedINDIVIDUAL #