Provider Demographics
NPI:1104069848
Name:HODGE, JASON (CERTIFIED MEDICAL EX)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:HODGE
Suffix:
Gender:M
Credentials:CERTIFIED MEDICAL EX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21938 ROYAL MONTREAL
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450
Mailing Address - Country:US
Mailing Address - Phone:281-500-6055
Mailing Address - Fax:281-500-6056
Practice Address - Street 1:21938 ROYAL MONTREAL
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450
Practice Address - Country:US
Practice Address - Phone:281-500-6055
Practice Address - Fax:281-500-6056
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner