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Individual
BLAKE M HODGES
Active
Individual
BLAKE M HODGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35680
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3255
MEDICARE PTAN
SC
05
—
356803
—
SC
01
—
423971
MEDICARE GROUP PTAN
SC
01
—
RHC210
GROUP MEDICAID
SC
Enumeration date
06/14/2013
Last updated
01/06/2023
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