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Individual

HEIDI L LODGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
100 E 5TH ST, STE 350, DOUGLAS, AZ 85607-2859
(520) 364-7659
(520) 364-8541
Mailing address
101 COLE AVE, BISBEE, AZ 85603-1327
(520) 432-6481
(520) 432-5082

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22674
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
892887
AZ
Enumeration date
05/20/2006
Last updated
08/12/2022
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