Individual
DR. ETHAN DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 W THOMAS RD STE 250, PHOENIX, AZ 85013-4215
(602) 406-3520
(602) 406-6162
Mailing address
PO BOX 33269, PHOENIX, AZ 85067-3269
(602) 406-4786
(916) 636-4358
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
60154
AZ
Other
Enumeration date
05/04/2017
Last updated
12/09/2024
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