Provider Demographics
NPI:1548277593
Name:DODSON, WILLIAM HAROLD III (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HAROLD
Last Name:DODSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9049
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9049
Mailing Address - Country:US
Mailing Address - Phone:303-415-8900
Mailing Address - Fax:303-443-6476
Practice Address - Street 1:1645 BROADWAY
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6218
Practice Address - Country:US
Practice Address - Phone:303-415-8900
Practice Address - Fax:303-443-6476
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95-225207Q00000X
CODR.0047338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58372822Medicaid
NMH2605Medicaid
G16409Medicare UPIN
NMH2605Medicaid