Provider Demographics
NPI:1073591848
Name:HEDGES, TONY GENE (DO)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:GENE
Last Name:HEDGES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 E HWY 377
Mailing Address - Street 2:SUITE B AND C
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-7960
Mailing Address - Country:US
Mailing Address - Phone:682-205-1079
Mailing Address - Fax:682-214-3222
Practice Address - Street 1:2214 E HWY 377
Practice Address - Street 2:SUITE B AND C
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-7960
Practice Address - Country:US
Practice Address - Phone:682-205-1079
Practice Address - Fax:682-214-3222
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N67TOtherBCBS CLINIC B GROUP
TX114852124OtherLHC FIRSTCARE
TX136411902Medicaid
TX162693901OtherLHC MEDICAID
TX8J9142OtherBCBS
TXCG5760OtherMEDICARE RAILROAD GROUP
TX080060101OtherMEDICARE RAILROAD
TX084272601OtherLCMC GROUP MCAID
TX114852125OtherFIRSTCARE B IND
TX85W781OtherBCBS IND
TX10009196OtherAMERIGROUP
TX8J9142OtherBCBS
TX084272601OtherLCMC GROUP MCAID
TX10009196OtherAMERIGROUP