Healthcare Provider Details

I. General information

NPI: 1700856432
Provider Name (Legal Business Name): LEROY W HODGES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 CHATBURN AVE
HARLAN IA
51537-2009
US

IV. Provider business mailing address

1220 CHATBURN AVE
HARLAN IA
51537-2009
US

V. Phone/Fax

Practice location:
  • Phone: 712-755-4376
  • Fax: 712-755-4347
Mailing address:
  • Phone: 712-755-4376
  • Fax: 712-755-4347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number66366
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-50086
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number30115
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: