Provider Demographics
NPI:1487840716
Name:HODGES, TYRON LAMARR (IDC)
Entity Type:Individual
Prefix:MR
First Name:TYRON
Middle Name:LAMARR
Last Name:HODGES
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NATIONAL NAVAL MEDICAL CENTER BETHESDA
Mailing Address - Street 2:8901 ROCKVILLE PIKE
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5600
Mailing Address - Country:US
Mailing Address - Phone:301-295-1032
Mailing Address - Fax:301-319-8240
Practice Address - Street 1:NATIONAL NAVAL MEDICAL CENTER BETHESDA
Practice Address - Street 2:8901 ROCKVILLE PIKE
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5600
Practice Address - Country:US
Practice Address - Phone:301-295-1032
Practice Address - Fax:301-319-8240
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman