Provider Demographics
NPI:1427029172
Name:HODGE, JERRY J III (DO)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:J
Last Name:HODGE
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 482 BOX 2535
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:96362-2599
Mailing Address - Country:US
Mailing Address - Phone:312-643-7285
Mailing Address - Fax:
Practice Address - Street 1:PSC 482 BOX 2535
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:96362-2599
Practice Address - Country:US
Practice Address - Phone:312-643-7285
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 5580207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology