Individual
JEFFREY SCOTT DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3036 NE MLK JR BLVD, PORTLAND, OR 97212-3053
(503) 889-2500
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/10/2022
Last updated
01/10/2022
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