Healthcare Provider Details

I. General information

NPI: 1790860401
Provider Name (Legal Business Name): DENNIS L HODGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9110 ANDERMATT DR STE 2
LINCOLN NE
68526-6701
US

IV. Provider business mailing address

9110 ANDERMATT DR STE 2
LINCOLN NE
68526-6701
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-7641
  • Fax: 402-483-0527
Mailing address:
  • Phone: 402-483-7641
  • Fax: 402-483-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number13085
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: