Provider Demographics
NPI:1487681672
Name:HODO, DAVID W (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:W
Last Name:HODO
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 1334
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-1334
Mailing Address - Country:US
Mailing Address - Phone:334-872-6773
Mailing Address - Fax:334-874-6257
Practice Address - Street 1:800 TREMONT STREET
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701
Practice Address - Country:US
Practice Address - Phone:334-872-6773
Practice Address - Fax:334-874-6257
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000058972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000002950Medicaid
51002950OtherBLUE CROSS
51002950OtherBLUE CROSS
C75813Medicare UPIN