Healthcare Provider Details

I. General information

NPI: 1831535863
Provider Name (Legal Business Name): MEGAN GENTRY HODGES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN GENTRY COOK

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIRCLE #1600 CENTRACARE CLINIC HEALTH PLAZA RADIOLOGY/ONCOLOGY
ST CLOUD MN
56303-5000
US

IV. Provider business mailing address

1900 CENTRACARE CIRCLE #1600 CENTRACARE CLINIC HEALTH PLAZA RADIOLOGY/ONCOLOGY
ST CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-4901
  • Fax: 320-229-4920
Mailing address:
  • Phone: 320-229-4901
  • Fax: 320-229-4920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number62184
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: