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NPI Code Detail

MEDICARE: JOHN BART HODGENS PH.D.

MEDICARE: JOHN BART HODGENS PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC2200XClinical Child & Adolescent Psychologist475AL
2103TC0700XClinical PsychologistPY8338FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2051075068OTHERALBLUECROSS AND BLUESHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710106521
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN BART HODGENS PH.D.
Provider Business Mailing Address
First Line : 700 8TH AVE W STE 101
Second Line :
City : PALMETTO
State : FL
Zip : 34221-4737
Country : US
Telephone Number : 941-776-4000
Fax Number : 941-845-4963
Provider Business Practice Location Address
First Line : 5325 26TH ST W
Second Line :
City : BRADENTON
State : FL
Zip : 34207-3012
Country : US
Telephone Number : 941-752-7173
Fax Number : 941-567-6277
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2007
Last Update Date : 11/09/2018

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