Provider Demographics
NPI:1942238803
Name:DODSON, STANTON FORREST (MD)
Entity type:Individual
Prefix:
First Name:STANTON
Middle Name:FORREST
Last Name:DODSON
Suffix:
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 1:670 GLADES ROAD
Mailing Address - Street 2:SUITE #300
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6464
Mailing Address - Country:US
Mailing Address - Phone:561-395-2626
Mailing Address - Fax:561-395-7026
Practice Address - Street 1:701 NW 13TH STREET
Practice Address - Street 2:SUITE 3097
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486
Practice Address - Country:US
Practice Address - Phone:561-955-6631
Practice Address - Fax:561-955-7258
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-106378204F00000X
FLME115150204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL95224Medicare ID - Type Unspecified
ILF55369Medicare UPIN