Provider Demographics
NPI:1295753531
Name:DODGE, JAIME KENT (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:KENT
Last Name:DODGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 RED ROCK LN STE 300
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6528
Mailing Address - Country:US
Mailing Address - Phone:531-333-2037
Mailing Address - Fax:531-205-2245
Practice Address - Street 1:5445 RED ROCK LN STE 300
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6528
Practice Address - Country:US
Practice Address - Phone:531-333-2037
Practice Address - Fax:531-205-2245
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2025-09-16
Deactivation Date:2024-02-27
Deactivation Code:
Reactivation Date:2024-03-26
Provider Licenses
StateLicense IDTaxonomies
IA37925207Q00000X
NE22564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1295753531Medicaid
146190027Medicare PIN
H92793Medicare UPIN
IA1295753531Medicaid