Healthcare Provider Details

I. General information

NPI: 1215937073
Provider Name (Legal Business Name): DANIEL LEE HODGES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 KALISTE SALOOM RD SUITE 100
LAFAYETTE LA
70508-5783
US

IV. Provider business mailing address

1103 KALISTE SALOOM RD SUITE 100
LAFAYETTE LA
70508-5783
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-5234
  • Fax: 337-235-2121
Mailing address:
  • Phone: 337-234-5234
  • Fax: 337-235-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number07019R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: