MEDICARE: MELVIN D. HODDE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	R5P19	MO
2	207P00000X	Emergency Medicine Physician	11449A	WY
3	207P00000X	Emergency Medicine Physician	R5P19	MO

General Provider Information

NPI Number	:	1144297599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVIN D. HODDE DO

Provider Business Mailing Address
First Line	:	2221 ELM ST
Second Line	:
City	:	RAWLINS
State	:	WY
Zip	:	82301-5108
Country	:	US
Telephone Number	:	307-324-2221
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 S PINE ST
Second Line	:
City	:	PIERCE CITY
State	:	MO
Zip	:	65723-1409
Country	:	US
Telephone Number	:	417-476-5140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	04/23/2018

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