Individual
MR. MARIO DONALD HODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.PED
Contact information
Practice address
1024 JORDAN ST, MOUNT VERNON, IL 62864-4231
(618) 242-4442
(618) 242-3942
Mailing address
1024 JORDAN ST, MOUNT VERNON, IL 62864-4231
(618) 242-4442
(618) 242-3942
Taxonomy
Speciality
Code
Description
License number
State
224L00000X
Pedorthist
Primary
212.000161
IL
Other
Enumeration date
09/25/2012
Last updated
09/25/2012
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