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General NPI Number Information
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NPI Number | 1932556826
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Entity Type | Individual
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Provider Name | BENJAMIN DODGE MD
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Gender | Male
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Dates
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Enumeration Date | 05/20/2016
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Last Update Date | 09/06/2019
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Provider Practice Location Address
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Address Line | FORT DEFIANCE INDIAN HOSPITAL BOARD INC. CORNER OF ROUTES N12 & N7
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City | FORT DEFIANCE
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State | AZ
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Zip | 86504
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Country | US
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Telephone | 928-729-8097
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2035
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City | WINDOW ROCK
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State | AZ
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Zip | 86515-2035
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Country | US
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Telephone | 505-710-6592
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2019-0276
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License Number State | NM
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