Healthcare Provider Details

I. General information

NPI: 1679676795
Provider Name (Legal Business Name): TIMOTHY M HODGES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 PINECROFT DR SUITE 250
SHENANDOAH TX
77380-3279
US

IV. Provider business mailing address

9200 PINECROFT DR SUITE 250
SHENANDOAH TX
77380-3279
US

V. Phone/Fax

Practice location:
  • Phone: 281-419-8400
  • Fax:
Mailing address:
  • Phone: 281-419-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01070094
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberM4815
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: