Provider Demographics
NPI:1144233826
Name:HODGE, GEOFF (ARNP)
Entity Type:Individual
Prefix:
First Name:GEOFF
Middle Name:
Last Name:HODGE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3835
Mailing Address - Country:US
Mailing Address - Phone:866-904-7721
Mailing Address - Fax:509-575-8685
Practice Address - Street 1:1117 TIETON DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3835
Practice Address - Country:US
Practice Address - Phone:866-904-7721
Practice Address - Fax:509-576-8685
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9617689Medicaid