Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 04-13053 | KS |
NPI | 1346347937 |
---|---|
Provider Name | Bruce E Hodges |
First Address | Birmingham, AL 35287-9387 |
Second Address | Overland Park, KS 66215-2306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 20/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100093230D | (05) | KS |
100093230E | (05) | KS |
1346347937 | (05) | MO |
C51585 | (02) | KS |