Dodge, Elmer G

Dodge, Elmer G is an individual health care provider with primary practice located at 9858 W State St , Star ID 83669-5210. He recently has 2 registered licenses in different health care specialties including Nursing Service Providers / General Practice, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is his primary health care specialty. Dodge, Elmer G can be contacted via phone (208) 286-0666.

Contact Information

Primary practice address
9858 W State St Star ID 83669-5210
Phone: (208) 286-0666
Fax: (208) 286-0565
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / General Practice 163WG0000X NP534A Idaho
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X NP-534A Idaho

Profile Details

NPI number 1508918236
LBN Legal business name Dodge, Elmer G
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 16th, 2007
Last updated Sep 1st, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508918236 NPPES
Idaho Other NPQP7 BLUE CROSS OF IDAHO
Idaho Other 000010150031 BLUE CROSS OF IDAHO
Idaho MEDICAID 806045400 BLUE CROSS OF IDAHO

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