Provider Demographics
NPI:1922171776
Name:DODDS, BRIAN LESLIE (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LESLIE
Last Name:DODDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 W BELLA CASA DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-3101
Mailing Address - Country:US
Mailing Address - Phone:719-252-2853
Mailing Address - Fax:
Practice Address - Street 1:115 N 10TH ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3460
Practice Address - Country:US
Practice Address - Phone:719-275-3288
Practice Address - Fax:719-269-7115
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42745207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00140151OtherRAILROAD MEDICARE
CO9000178152Medicaid
COD0669947OtherANTHEM BC BS
P00140151OtherRAILROAD MEDICARE
541158Medicare PIN