Provider Demographics
NPI:1396734448
Name:HODGES, PAMELA S (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:HODGES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 IMPERIAL BLVD STE B2
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4689
Mailing Address - Country:US
Mailing Address - Phone:813-684-2229
Mailing Address - Fax:813-413-8507
Practice Address - Street 1:215 IMPERIAL BLVD STE B2
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4689
Practice Address - Country:US
Practice Address - Phone:813-684-2229
Practice Address - Fax:813-413-8507
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19018207V00000X
FLME134220207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64190184Medicaid
KYC69300Medicare UPIN
KYK194680Medicare PIN