Provider Demographics
NPI:1063481216
Name:HODGES, WILLARD JEFFERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:JEFFERSON
Last Name:HODGES
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 1:103 CONTINENTAL PL
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1041
Mailing Address - Country:US
Mailing Address - Phone:615-916-3200
Mailing Address - Fax:615-658-8389
Practice Address - Street 1:6116 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5752
Practice Address - Country:US
Practice Address - Phone:303-512-0888
Practice Address - Fax:303-512-2288
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19412207ZP0102X, 207ZP0213X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTZ0733Medicaid
CO01194125Medicaid
AZ641656Medicaid
E67593Medicare UPIN
COC220348Medicare PIN
CO01194125Medicaid