Kodjo Adam Dodo, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

999122 Issued in IL

Practice address

4430 Missouri Ave
Fort Leonard Wood, MO 65473-9098

Phone

(573) 596-0417

NPI assigned

Jul 6, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• United States Army

  • Military Hospital
  • Fort Leonard Wood, MO
  • NPI 1902263098
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1593993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593993600000",
    "number": "1538787643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4430 MISSOURI AVENUE",
            "address_2": "BOX 1267 ATTN: DQS-CR",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "65473",
            "telephone_number": "573-596-0417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4430 MISSOURI AVE",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654739098",
            "telephone_number": "573-596-0417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DODO",
        "first_name": "KODJO",
        "middle_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-06",
        "last_updated": "2020-07-06",
        "certification_date": "2020-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "999122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessie Marie Dickinson, RD, LD
• Samantha Renee Dickow, LPCC
• Angela Renee Diebal-Lee, DPT, DSC, OCS, SCS
• Teresa Anne Distler, NP-C
• Nicholas Dobbs
• Brock Justin Dodsworth, PTA
• Jessica Dolan, RDN
• Justin Marshall Dominguez, DPT
• Maria Mercedes Dominguez, PHD, LMFT
• Crystal Le-Ann Dornbach-Poojari, PHARM. D.

• Registered Dietitian in Fort Leonard Wood, MO
• Providers in Fort Leonard Wood, MO by specialty
• Registered Dietitian in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.