Basic Information
| Provider Information | |||||||||
| NPI: | 1275755688 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DODD | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | PAYNE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 CLARK ST. NE | ||||||||
| Address2: | |||||||||
| City: | CULLMAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567368875 | ||||||||
| FaxNumber: | 2567390027 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 AL HWY 157 | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CULLMAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350580600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567394131 | ||||||||
| FaxNumber: | 2567396027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 04/28/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | L-2791 | AL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 28382 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1275755688 | 05 | AL | MEDICAID | 1275755688 | 01 | AL | UNITED HEALTH CARE | OTHER | 111611 | 01 | AL | MEDICAID ID | OTHER | 51032953 | 01 | AL | BCBS OF ALABAMA | OTHER | 102I089982 | 01 | AL | MEDICARE ID | OTHER | 1598717381 | 01 | AL | MEDICAID GROUP NPI | OTHER | E869 | 01 | AL | MEDICARE GROUP | OTHER | P00742760 | 01 | AL | MEDICARE RR | OTHER |