Healthcare Provider Details

I. General information

NPI: 1356780209
Provider Name (Legal Business Name): PAUL A. HODGES RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 3RD ST NW
ALBUQUERQUE NM
87102-1403
US

IV. Provider business mailing address

1201 3RD ST NW
ALBUQUERQUE NM
87102-1403
US

V. Phone/Fax

Practice location:
  • Phone: 505-764-8231
  • Fax: 505-248-1351
Mailing address:
  • Phone: 505-764-8231
  • Fax: 505-248-1351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number739015
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: