Provider Demographics
NPI:1669586269
Name:HODGSON, JOHN MCBARRON (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MCBARRON
Last Name:HODGSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S 8TH ST STE 480W
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2403
Mailing Address - Country:US
Mailing Address - Phone:270-762-1321
Mailing Address - Fax:
Practice Address - Street 1:300 S 8TH ST STE 180W
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2444
Practice Address - Country:US
Practice Address - Phone:270-762-1560
Practice Address - Fax:270-752-2861
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435886207RC0000X, 207RI0011X
KY56062207RC0000X
OH35058413207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA102229549Medicaid
OH076050Medicaid
KY7100807190Medicaid