Healthcare Provider Details

I. General information

NPI: 1619937273
Provider Name (Legal Business Name): JOHN C. HODGES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N PATRICK STREET
DUBLIN TX
76446-1918
US

IV. Provider business mailing address

303 N PATRICK STREET
DUBLIN TX
76446-1918
US

V. Phone/Fax

Practice location:
  • Phone: 254-445-4900
  • Fax: 254-445-4693
Mailing address:
  • Phone: 254-445-4900
  • Fax: 254-445-4693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberF9566
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: