Provider Demographics
NPI:1184779217
Name:HODEL, CARL F (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:F
Last Name:HODEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-2135 FORT WEAVER RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-1940
Mailing Address - Country:US
Mailing Address - Phone:808-676-5331
Mailing Address - Fax:808-671-2931
Practice Address - Street 1:91-2135 FORT WEAVER RD
Practice Address - Street 2:SUITE 170
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-1940
Practice Address - Country:US
Practice Address - Phone:808-676-5331
Practice Address - Fax:808-671-2931
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-2688207P00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0042893OtherHMSA
HI039082-01Medicaid
HI00A0042893OtherHMSA
HI039082-01Medicaid