Individual
ELMER G DODGE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
9858 W STATE ST, STAR, ID 83669-5210
(208) 286-0666
(208) 286-0565
Mailing address
PO BOX 44267, BOISE, ID 83711-0267
(208) 286-0666
(208) 286-0565
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
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us