Provider Demographics
NPI:1457357907
Name:HODGES, JOHN MCIVER SR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MCIVER
Last Name:HODGES
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1325 EASTMORELAND AVE
Mailing Address - Street 2:STE 450
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-7535
Mailing Address - Country:US
Mailing Address - Phone:901-543-5499
Mailing Address - Fax:901-726-5889
Practice Address - Street 1:1325 EASTMORELAND AVE
Practice Address - Street 2:STE 450
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7535
Practice Address - Country:US
Practice Address - Phone:901-543-5499
Practice Address - Fax:901-726-5889
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN4796207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101921001Medicaid
AR101921001Medicaid
B02176Medicare UPIN
AR52402Medicare ID - Type Unspecified