| Doctor Name: | DR. LORRAINE M DODSON |
| NPI Number: | 1619970761 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | R5P04 |
| Business Practice Address: | 1241 W Stadium Blvd Ste 102 Jefferson City, MO - 651096023 |
| Business Phone Number: | 5736365248 |
| Business Fax Number: | 5736369390 |
| Mailing Address: | Po Box 104240, JEFFERSON CITY |
| State: | MO |
| Postal Code: | 651104240 |
| Phone Number: | 5736355264 |
| Fax Number: | |
| NPI Enumeration Date: | 05/23/2005 |
| NPI Last Update Date: | 06/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | R5P04 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |