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Individual

JACQUELINE CELESTE HODGE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
5001 STATESMAN DR, C/O STAFFCARE, INC., IRVING, TX 75063-2414
(800) 685-2272
(972) 983-0254
Mailing address
PORZELLANGASSE 19/2/1, VIENNA, VIENNA 1090

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
171821
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
171821
MEDICAL LICENSE
NY
01
2005025948
MEDICAL LICENSE
MO
Enumeration date
07/16/2007
Last updated
07/16/2007
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