Provider Demographics
NPI:1316376361
Name:HODY, GEORGE LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LAWRENCE
Last Name:HODY
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 9669
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92169-0669
Mailing Address - Country:US
Mailing Address - Phone:858-452-3224
Mailing Address - Fax:
Practice Address - Street 1:6120 CAMINITO BAEZA
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-3407
Practice Address - Country:US
Practice Address - Phone:858-452-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-09
Last Update Date:2013-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC32777208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice