Provider Demographics
NPI:1124294715
Name:HODGE, RONA ELSBERTH (MD,)
Entity type:Individual
Prefix:DR
First Name:RONA
Middle Name:ELSBERTH
Last Name:HODGE
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HUGHES MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:0
Mailing Address - Zip Code:AI2640
Mailing Address - Country:AI
Mailing Address - Phone:264-476-0732
Mailing Address - Fax:264-497-8765
Practice Address - Street 1:201 HUGHES MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:0
Practice Address - Zip Code:AI2640
Practice Address - Country:AI
Practice Address - Phone:264-476-0732
Practice Address - Fax:264-497-8765
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23108208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSF06474Medicare UPIN