Healthcare Provider Details

I. General information

NPI: 1154473387
Provider Name (Legal Business Name): SHEILA M. HODGSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 FLORIDA AVE STE 200
MODESTO CA
95350
US

IV. Provider business mailing address

1541 FLORIDA AVE STE 200
MODESTO CA
95350-4438
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-3388
  • Fax: 209-523-7583
Mailing address:
  • Phone: 209-577-3388
  • Fax: 209-523-7583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA72294
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA72294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: