Healthcare Provider Details

I. General information

NPI: 1033412093
Provider Name (Legal Business Name): HODGE FLORIDA ORTHOPEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 UNIVERSITY BLVD SUITE 104
JUPITER FL
33458-2788
US

IV. Provider business mailing address

5500 MILITARY TRL SUITE 22 273
JUPITER FL
33458-2869
US

V. Phone/Fax

Practice location:
  • Phone: 561-630-8603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberME 49712
License Number StateFL

VIII. Authorized Official

Name: DR. WILLIAM ANDREW HODGE
Title or Position: MEMBER
Credential: MD
Phone: 303-968-4181