| Doctor Name: | KEVIN C DODSON |
| NPI Number: | 1629076559 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 016004304 |
| Business Practice Address: | 1620 9th St East Moline, IL - 612442120 |
| Business Phone Number: | 3097553809 |
| Business Fax Number: | 3097553860 |
| Mailing Address: | 1620 9th St, EAST MOLINE |
| State: | IL |
| Postal Code: | 612442120 |
| Phone Number: | 3097553809 |
| Fax Number: | 3097553860 |
| NPI Enumeration Date: | 07/13/2005 |
| NPI Last Update Date: | 10/12/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 016004304 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |