Dodge, Jake Daniel

Dodge, Jake Daniel is an individual health care provider with primary practice located at 4700 Las Vegas Blvd N , Nellis Afb NV 89191-6600. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Dodge, Jake Daniel can be contacted via phone (915) 540-1431.

Contact Information

Primary practice address
4700 Las Vegas Blvd N Nellis Afb NV 89191-6600
Phone: (915) 540-1431
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X DR.0069622 Colorado
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X SL1306 Nevada

Profile Details

NPI number 1114410784
LBN Legal business name Dodge, Jake Daniel
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 8th, 2018
Last updated Apr 17th, 2024 - about last year

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 1114410784 NPPES
Colorado Other 029551 KAISER COMMERCIAL NUMBER
Colorado Other SL1306 KAISER COMMERCIAL NUMBER

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