Healthcare Provider Details

I. General information

NPI: 1194757849
Provider Name (Legal Business Name): JERRY F HODGES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N 4TH ST
DARDANELLE AR
72834-3713
US

IV. Provider business mailing address

PO BOX 637
DARDANELLE AR
72834-0637
US

V. Phone/Fax

Practice location:
  • Phone: 479-229-2827
  • Fax: 479-229-5749
Mailing address:
  • Phone: 479-229-2827
  • Fax: 479-229-5749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC5406
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC5406
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: