DR. JAKE DANIEL DODGE DO NPI 1114410784

NPI Information

NPI: 1114410784
Provider Name: DR. JAKE DANIEL DODGE, DO
Classification: Family Medicine - 207Q00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
4700 LAS VEGAS BLVD N
NELLIS AFB, NV
ZIP 89191
Phone: (915) 540-1431
Get Directions

DR. Jake Daniel Dodge, DO is a family medicine in Nellis Afb, NV. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DR. Jake Daniel Dodge, DO NPI is 1114410784. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4700 LAS VEGAS BLVD N
NELLIS AFB, NV
ZIP 89191-600
Phone: (915) 540-1431

The NPI 1114410784 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/8/2018 and was last updated on 4/17/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		DR.0069622	COLORADO	No
2	207Q00000X	Family Medicine		SL1306	NEVADA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	029551	OTHER	COLORADO	KAISER COMMERCIAL NUMBER
2	SL1306	OTHER	NEVADA	NEVADA STATE LICENSING BOARD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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