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Individual
ELMER G DODGE JR.
Active
Individual
ELMER G DODGE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
NP534A
ID
363L00000X
Nurse Practitioner
Primary
NP-534A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010150031
REGENCE BLUE SHIELD OF ID
ID
05
—
806045400
—
ID
01
—
NPQP7
BLUE CROSS OF IDAHO
ID
Enumeration date
01/16/2007
Last updated
09/01/2020
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