Individual
DR. BENJAMIN M DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
550CLUB LANE, SUITE 1, CONWAY, AR 72034-3681
(501) 329-1510
(501) 329-5697
Mailing address
550 CLUB LN, SUITE 1, CONWAY, AR 72034-3681
(501) 329-1510
(501) 329-5697
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
C7472
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123211001
—
AR
01
—
12593000000
QUALCHOICE
AR
01
—
200016131
RR MEDICARE
AR
01
—
5J081
BCBS
AR
Enumeration date
08/19/2005
Last updated
11/05/2007
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