Provider Demographics
NPI:1508862863
Name:HODGE, RICHARD GORDON (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GORDON
Last Name:HODGE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11995 SINGLETREE LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:3640 ASPEN HOLW
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3289
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2015-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV82072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology