Provider Demographics
NPI:1932543691
Name:CHERYL HODGES MD
Entity Type:Organization
Organization Name:CHERYL HODGES MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-276-2978
Mailing Address - Street 1:1365 E PARKS HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8284
Mailing Address - Country:US
Mailing Address - Phone:907-357-9920
Mailing Address - Fax:
Practice Address - Street 1:1365 E PARKS HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8284
Practice Address - Country:US
Practice Address - Phone:907-357-9920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK63692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty