Individual
DR. JAKE DANIEL DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4700 LAS VEGAS BLVD N, NELLIS AFB, NV 89191-6600
(915) 540-1431
Mailing address
4700 LAS VEGAS BLVD N, NELLIS AFB, NV 89191-6600
(915) 540-1431
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
DR.0069622
CO
207Q00000X
Family Medicine Physician
Primary
SL1306
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
029551
KAISER COMMERCIAL NUMBER
CO
01
—
SL1306
NEVADA STATE LICENSING BOARD
NV
Enumeration date
06/08/2018
Last updated
04/17/2024
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