Provider Demographics
NPI:1992998819
Name:HODGE, JAMES R (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:HODGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3520 GUION RD
Mailing Address - Street 2:#307
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222
Mailing Address - Country:US
Mailing Address - Phone:317-923-1033
Mailing Address - Fax:317-927-7426
Practice Address - Street 1:3520 GUION RD
Practice Address - Street 2:SUITE 307
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222
Practice Address - Country:US
Practice Address - Phone:317-923-1033
Practice Address - Fax:317-927-7426
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN02003140B208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A74030Medicare UPIN