Provider Demographics
NPI:1578609632
Name:HODAN, GERALD (PSYD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:HODAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 37TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-1620
Mailing Address - Country:US
Mailing Address - Phone:727-399-0806
Mailing Address - Fax:866-469-3880
Practice Address - Street 1:3745 5TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7519
Practice Address - Country:US
Practice Address - Phone:727-399-0806
Practice Address - Fax:866-469-3880
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2871103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59499OtherBLUE SHIELD OF FL
FL59499OtherBLUE SHIELD OF FL