Provider Demographics
NPI:1588639363
Name:HODGE, ARTHUR J (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:J
Last Name:HODGE
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 1:2195 RINGLING BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-7003
Mailing Address - Country:US
Mailing Address - Phone:941-362-0304
Mailing Address - Fax:941-362-0593
Practice Address - Street 1:2195 RINGLING BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-7003
Practice Address - Country:US
Practice Address - Phone:941-362-0304
Practice Address - Fax:941-362-0593
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 37099-L207R00000X
FLME97919207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA005739OtherHIGHMARK BLUE SHIELD
PAC26161Medicare UPIN
PA005739Medicare ID - Type Unspecified