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General NPI Number Information
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NPI Number | 1194757849
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Entity Type | Individual
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Provider Name | JERRY F HODGES M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 08/28/2014
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Provider Practice Location Address
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Address Line | 215 N 4TH ST
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City | DARDANELLE
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State | AR
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Zip | 72834-3713
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Country | US
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Telephone | 479-229-2827
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Fax | 479-229-5749
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Provider Business Mailing Address
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Address Line | PO BOX 637
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City | DARDANELLE
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State | AR
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Zip | 72834-0637
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Country | US
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Telephone | 479-229-2827
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Fax | 479-229-5749
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | C5406
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C5406
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License Number State | AR
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