Healthcare Provider Details

I. General information

NPI: 1154680486
Provider Name (Legal Business Name): CLAYTON THOMAS HODGES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 OLYMPIC PLAZA CIR STE 600
TYLER TX
75701-1954
US

IV. Provider business mailing address

11937 US HIGHWAY 271
TYLER TX
75708-3154
US

V. Phone/Fax

Practice location:
  • Phone: 903-596-3844
  • Fax: 903-596-3843
Mailing address:
  • Phone: 903-877-8773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberT3482
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA126999
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberT3482
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberT3482
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: