Organization
BRENT STREET FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT F DODGE M.D (PRESIDENT)
(805) 641-2000
Entity
Organization
Contact information
Practice address
168 N BRENT ST, STE 502, VENTURA, CA 93003-2817
(805) 641-2000
(805) 653-1644
Mailing address
168 N BRENT ST, STE 502, VENTURA, CA 93003-2817
(805) 641-2000
(805) 653-1644
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
G26650
CA
207Q00000X
Family Medicine Physician
G40594
CA
207Q00000X
Family Medicine Physician
Primary
G43925
CA
207Q00000X
Family Medicine Physician
G46052
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G266500
—
CA
05
—
00G405940
—
CA
05
—
00G439250
—
CA
05
—
00G460520
—
CA
Enumeration date
01/18/2007
Last updated
08/22/2020
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