Provider Demographics
NPI:1134650161
Name:FEELER, DODGE (NP-C)
Entity Type:Individual
Prefix:
First Name:DODGE
Middle Name:
Last Name:FEELER
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 ESTONIA CV
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-5015
Mailing Address - Country:US
Mailing Address - Phone:210-253-9955
Mailing Address - Fax:210-485-6253
Practice Address - Street 1:1806 ESTONIA CV
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-5015
Practice Address - Country:US
Practice Address - Phone:210-253-9955
Practice Address - Fax:210-485-6253
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX846965164W00000X
TXAP133633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse