Provider Demographics
NPI:1609926039
Name:HODGES, JOHN L (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:HODGES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 GARDEN GATE CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8629
Mailing Address - Country:US
Mailing Address - Phone:850-478-0008
Mailing Address - Fax:850-494-1817
Practice Address - Street 1:900 GARDEN GATE CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8629
Practice Address - Country:US
Practice Address - Phone:850-478-0008
Practice Address - Fax:850-494-1817
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003505103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL281711OtherVALUE OPTIONS
FL75993OtherBLUE CROSS AND BLUE SHIEL
FL281711OtherVALUE OPTIONS