Provider Demographics
NPI:1932060639
Name:HODGES, CORY DAN
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:DAN
Last Name:HODGES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 CULBERTSON ST SW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-5307
Mailing Address - Country:US
Mailing Address - Phone:580-465-0718
Mailing Address - Fax:
Practice Address - Street 1:1105 CULBERTSON ST SW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5307
Practice Address - Country:US
Practice Address - Phone:580-465-0718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-21
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist