Healthcare Provider Details

I. General information

NPI: 1821444183
Provider Name (Legal Business Name): JAMES DODGE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 JEFFERSON BLVD STE B180
WEST SACRAMENTO CA
95605-2394
US

IV. Provider business mailing address

500 JEFFERSON BLVD STE B180
WEST SACRAMENTO CA
95605-2394
US

V. Phone/Fax

Practice location:
  • Phone: 916-403-2900
  • Fax: 530-204-5248
Mailing address:
  • Phone: 916-403-2900
  • Fax: 530-204-5248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16382
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: