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NPI Code Detail

MEDICARE: DR. RODNEY WAYNE DODGE M.D.

MEDICARE: DR. RODNEY WAYNE DODGE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianMD16690OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003855685
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RODNEY WAYNE DODGE M.D.
Provider Business Mailing Address
First Line : 3655 SW TUNNELWOOD ST
Second Line :
City : PORTLAND
State : OR
Zip : 97221-4146
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 335 SE 8TH AVE
Second Line :
City : HILLSBORO
State : OR
Zip : 97123-4246
Country : US
Telephone Number : 503-681-1111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2006
Last Update Date : 07/08/2007

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