Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 36000176A | IN |
N | 213ES0000X | Sports Medicine | 36000176A | IN |
NPI | 1508973165 |
---|---|
Provider Name | Mr. Jason Paul Hodde |
First Address | West Lafayette, IN 47906-2012 |
Second Address | West Lafayette, IN 47906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |