Healthcare Provider Details

I. General information

NPI: 1912356700
Provider Name (Legal Business Name): MAKENZIE HODGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 W LOOP 281 STE 300
LONGVIEW TX
75604-2934
US

IV. Provider business mailing address

1200 BINZ ST STE 1490
HOUSTON TX
77004-6946
US

V. Phone/Fax

Practice location:
  • Phone: 903-205-7920
  • Fax: 833-428-1336
Mailing address:
  • Phone: 713-512-7700
  • Fax: 832-767-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberT2624
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: