Individual
BRYCE DODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1477 SUE CIR, PIEDMONT, OK 73078-8975
(405) 763-8063
Mailing address
100 S MONROE ST STE 5, ELK CITY, OK 73644-5761
(405) 763-8063
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
11/18/2014
Last updated
11/18/2014
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