Provider Demographics
NPI:1558585000
Name:HODGINS, PAUL (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:HODGINS
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WOODHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:IL
Mailing Address - Zip Code:61548-9222
Mailing Address - Country:US
Mailing Address - Phone:309-636-1778
Mailing Address - Fax:309-675-1076
Practice Address - Street 1:100 NE ADAMS ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61629-1410
Practice Address - Country:US
Practice Address - Phone:309-636-1778
Practice Address - Fax:309-675-1076
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G 48373Medicare UPIN