Provider Demographics
NPI:1679836878
Name:DAVID W. HODO, M.D., P.A.
Entity Type:Organization
Organization Name:DAVID W. HODO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/M.D./PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:HODO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-872-6773
Mailing Address - Street 1:P.O. BOX 1334
Mailing Address - Street 2:800 TREMONT STREET
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-1334
Mailing Address - Country:US
Mailing Address - Phone:334-872-6773
Mailing Address - Fax:334-874-6257
Practice Address - Street 1:800 TREMONT STREET
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-5447
Practice Address - Country:US
Practice Address - Phone:334-872-6773
Practice Address - Fax:334-874-6257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000059872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
510-02950OtherBCBS
AL000002950Medicaid
AL000002950Medicaid
510-02950OtherBCBS