Healthcare Provider Details

I. General information

NPI: 1598258386
Provider Name (Legal Business Name): LEVI DODGE D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SUTTER PL
DAVIS CA
95616-6201
US

IV. Provider business mailing address

2000 SUTTER PL
DAVIS CA
95616-6201
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberNA
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: