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General NPI Number Information
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NPI Number | 1790266971
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Entity Type | Individual
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Provider Name | BENJAMIN HODGES PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 10/07/2022
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Provider Practice Location Address
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Address Line | 1504 MADISON AVE
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City | FORT ATKINSON
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State | WI
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Zip | 53538-3100
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Country | US
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Telephone | 920-563-7888
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 249
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City | FORT ATKINSON
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State | WI
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Zip | 53538-0249
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Country | US
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Telephone | 920-563-4466
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.006721
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 085.006721
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 085.006721
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5474-23
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License Number State | WI
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