Provider Demographics
NPI:1063494581
Name:HODGES, HARLAN DRU (MD)
Entity Type:Individual
Prefix:DR
First Name:HARLAN
Middle Name:DRU
Last Name:HODGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4853
Mailing Address - Street 2:DEPT 4036
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522-4853
Mailing Address - Country:US
Mailing Address - Phone:630-734-0200
Mailing Address - Fax:630-734-1560
Practice Address - Street 1:12303 DEPAUL DR
Practice Address - Street 2:DEPAUL HEALTH CENTER
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-344-6000
Practice Address - Fax:630-734-1560
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2019-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO118457207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205195522Medicaid
MO205195522Medicaid
H25207Medicare UPIN