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General NPI Number Information
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NPI Number | 1548498975
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Entity Type | Individual
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Provider Name | SHANE MICHAEL HODGE D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 102 PROFESSIONAL PARK STE C
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City | OXFORD
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State | NC
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Zip | 27565-2554
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Country | US
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Telephone | 919-603-0368
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Fax | 919-690-0842
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Provider Business Mailing Address
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Address Line | PO BOX 986
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City | OXFORD
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State | NC
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Zip | 27565-0986
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Country | US
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Telephone | 919-690-3487
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Fax | 919-690-3246
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2011-00897
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 5101016839
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License Number State | MI
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