Provider Demographics
NPI:1508910589
Name:DODGE, ROBERT F (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:DODGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:168 N BRENT ST
Mailing Address - Street 2:STE 502
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2817
Mailing Address - Country:US
Mailing Address - Phone:805-641-2000
Mailing Address - Fax:805-653-1644
Practice Address - Street 1:168 N BRENT ST
Practice Address - Street 2:STE 502
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2817
Practice Address - Country:US
Practice Address - Phone:805-641-2000
Practice Address - Fax:805-653-1644
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG043925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG043925OtherSTATE ID
CA00G439250Medicaid
CA00G439250Medicaid
CAWG43925CMedicare ID - Type Unspecified