Basic Information
| Provider Information | |||||||||
| NPI: | 1689681454 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DODSON | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 MAIN ST | ||||||||
| Address2: | SUITE 5200 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752014612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147122019 | ||||||||
| FaxNumber: | 2147122487 | ||||||||
| Practice Location | |||||||||
| Address1: | 1302 NW LAKE AVE | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735076577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803572304 | ||||||||
| FaxNumber: | 2147122487 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 10/25/2017 | ||||||||
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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 | 207P00000X | 4243 | OK | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 2010025332 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.