Provider Demographics
NPI:1003364712
Name:HODGES DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:HODGES DERMATOLOGY, PLLC
Other - Org Name:HODGES DERMATOLOGY, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEISA
Authorized Official - Middle Name:LACOMBE
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-215-0262
Mailing Address - Street 1:6100 WINDHAVEN PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8046
Mailing Address - Country:US
Mailing Address - Phone:214-615-1735
Mailing Address - Fax:214-615-1800
Practice Address - Street 1:6100 WINDHAVEN PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8046
Practice Address - Country:US
Practice Address - Phone:214-615-1735
Practice Address - Fax:214-615-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3692207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty