Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 4796 | TN |
NPI | 1457357907 |
---|---|
Provider Name | Dr. John Mciver Hodges SR. |
First Address | Memphis, TN 38104-7535 |
Second Address | Memphis, TN 38104-7535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 19/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101921001 | (05) | AR |
B02176 | (02) |