MEDICARE: MELVIN HODDE DO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	R5P19	MO

General Provider Information

NPI Number	:	1124488697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELVIN HODDE DO LLC

Provider Business Mailing Address
First Line	:	102 E CLEVELAND AVE
Second Line	:
City	:	MONETT
State	:	MO
Zip	:	65708-1405
Country	:	US
Telephone Number	:	417-476-7201
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 E CLEVELAND AVE
Second Line	:
City	:	MONETT
State	:	MO
Zip	:	65708-1405
Country	:	US
Telephone Number	:	417-476-7201
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	HASNAIN NAQVI
Credential	:
Telephone Number	:	859-321-9604

Provider Enumeration Date	:	02/26/2016
Last Update Date	:	02/26/2016

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Directions to “MELVIN HODDE DO LLC ” Practice Location

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