Provider Demographics
NPI:1265402291
Name:HODGES, JOSEPH AL JR (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:AL
Last Name:HODGES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:57635 HIGHWAY 12
Mailing Address - Street 2:PO BOX 340
Mailing Address - City:HATTERAS
Mailing Address - State:NC
Mailing Address - Zip Code:27943
Mailing Address - Country:US
Mailing Address - Phone:252-986-2756
Mailing Address - Fax:252-986-1201
Practice Address - Street 1:57635 HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:HATTERAS
Practice Address - State:NC
Practice Address - Zip Code:27943
Practice Address - Country:US
Practice Address - Phone:252-986-2756
Practice Address - Fax:252-986-1201
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7942710Medicaid
NC42710OtherBCBS
2170567MMedicare ID - Type Unspecified
2170567PMedicare ID - Type Unspecified
NC42710OtherBCBS