MEDICARE: DODGE FEELER NP-C

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
1	164W00000X	Licensed Practical Nurse	846965	TX
2	363LF0000X	Family Nurse Practitioner	AP133633	TX

General Provider Information

NPI Number	:	1134650161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DODGE FEELER NP-C

Provider Business Mailing Address
First Line	:	1806 ESTONIA CV
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-5015
Country	:	US
Telephone Number	:	210-253-9955
Fax Number	:	210-485-6253

Provider Business Practice Location Address
First Line	:	1806 ESTONIA CV
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-5015
Country	:	US
Telephone Number	:	210-253-9955
Fax Number	:	210-485-6253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2017
Last Update Date	:	05/30/2017

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Directions to “ DODGE FEELER NP-C” Practice Location

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