Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 4141 | TX |
NPI | 1285634014 |
---|---|
Provider Name | Dr. John Paul Hodges JR. |
First Address | League City, TX 77574-1688 |
Second Address | League City, TX 77573-3579 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 07/01/2008 |