Dr Jake Daniel Dodge, DO | |
4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 | |
(915) 540-1431 | |
Not Available |
Full Name | Dr Jake Daniel Dodge |
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Gender | Male |
Speciality | Family Medicine |
Location | 4700 Las Vegas Blvd N, Nellis Afb, Nevada |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1114410784 | NPI | - | NPPES |
029551 | Other | CO | KAISER COMMERCIAL NUMBER |
SL1306 | Other | NV | NEVADA STATE LICENSING BOARD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | DR.0069622 (Colorado) | Secondary |
207Q00000X | Family Medicine | SL1306 (Nevada) | Primary |
Entity Name | Colorado Permanente Medical Group Pc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1760599724 PECOS PAC ID: 1254238454 Enrollment ID: O20031216000640 |
Mailing Address | Practice Location Address |
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Dr Jake Daniel Dodge, DO 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 Ph: (915) 540-1431 | Dr Jake Daniel Dodge, DO 4700 Las Vegas Blvd N, Nellis Afb, NV 89191-6600 Ph: (915) 540-1431 |
Dr. Debra A Koenigsberger, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 4700 Las Vegas Blvd N, Nellis Afb, NV 89191 Phone: 702-653-2267 | |
Eileen Ly, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 4700 Las Vegas Blvd N, Nellis Afb, NV 89191 Phone: 702-653-2273 | |
Alisha Provost, DO Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 4700 Las Vegas Blvd N, Nellis Afb, NV 89191 Phone: 702-653-2273 | |
Noel R Colls, M.D. Family Medicine Medicare: Medicare Enrolled Practice Location: 4700 Las Vegas Blvd N, Nellis Afb, NV 89191 Phone: 702-653-2764 | |
Dr. Elizabeth Anne Landman, M.D. Family Medicine Medicare: Medicare Enrolled Practice Location: 4700 Las Vegas Blvd N, Nellis Afb, NV 89191 Phone: 702-653-2273 | |
Kristen Dorazio, DO Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 4700 Las Vegas Blvd N, Nellis Afb, NV 89191 Phone: 702-653-2273 | |
Dipti S Patel, DO Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 4700 Las Vegas Blvd N, Nellis Afb, NV 89191 Phone: 702-653-2965 |