Healthcare Provider Details

I. General information

NPI: 1629072137
Provider Name (Legal Business Name): RICHARD A HODES DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8521 W MCNAB RD
TAMARAC FL
33321-3209
US

IV. Provider business mailing address

8521 W MCNAB RD
TAMARAC FL
33321-3209
US

V. Phone/Fax

Practice location:
  • Phone: 954-721-1990
  • Fax: 954-721-1932
Mailing address:
  • Phone: 954-721-1990
  • Fax: 954-721-1932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO953
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: