Provider Demographics
NPI:1003801333
Name:HODDINOTT, KEVIN MARCELL (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MARCELL
Last Name:HODDINOTT
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:PO BOX 3130
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-3130
Mailing Address - Country:US
Mailing Address - Phone:352-867-8311
Mailing Address - Fax:352-867-1053
Practice Address - Street 1:1511 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6505
Practice Address - Country:US
Practice Address - Phone:352-368-1661
Practice Address - Fax:352-867-9794
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0578081208600000X
OH35-06-2777208600000X
FLME100609208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL281126000Medicaid
FL29763OtherBCBS
FLAN822ZMedicare PIN
FL29763OtherBCBS