Provider Demographics
NPI:1023316908
Name:JAMES T DODGE, D.O., LLC
Entity type:Organization
Organization Name:JAMES T DODGE, D.O., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:502877-349-1411
Mailing Address - Street 1:1905 W HEBRON LN
Mailing Address - Street 2:STE 205
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-7465
Mailing Address - Country:US
Mailing Address - Phone:877-349-1411
Mailing Address - Fax:502-349-0980
Practice Address - Street 1:1905 W HEBRON LN
Practice Address - Street 2:STE 205
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7465
Practice Address - Country:US
Practice Address - Phone:877-349-1411
Practice Address - Fax:502-349-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02609207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty