Basic Information
| Provider Information | |||||||||
| NPI: | 1770510489 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DODGE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 WASHINGTON ST | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192783300 | ||||||||
| FaxNumber: | 6192783310 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 WASHINGTON ST | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192783300 | ||||||||
| FaxNumber: | 6192783310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G67831 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.