1962596833 NPI number — MR. GREGORY CLAYTON HODGE MSW

Table of content: REHAN IFTIKHAR MD (NPI 1861400749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962596833 NPI number — MR. GREGORY CLAYTON HODGE MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HODGE
Provider First Name:
GREGORY
Provider Middle Name:
CLAYTON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962596833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1417 E FORT LOWELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85719-2310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-320-1440
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3601 S 6TH AVE
Provider Second Line Business Practice Location Address:
DEPT OF MENTAL HEALTH
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85723-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-792-1450
Provider Business Practice Location Address Fax Number:
520-629-4725
Provider Enumeration Date:
10/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW-3614 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)