Provider Demographics
NPI:1154680486
Name:HODGES, CLAYTON THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:THOMAS
Last Name:HODGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11937 US HIGHWAY 271
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75708-3154
Mailing Address - Country:US
Mailing Address - Phone:903-877-8773
Mailing Address - Fax:
Practice Address - Street 1:700 OLYMPIC PLAZA CIR STE 600
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1954
Practice Address - Country:US
Practice Address - Phone:903-596-3844
Practice Address - Fax:903-596-3843
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT3482207QS0010X, 207XX0005X, 207X00000X
CAA126999207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine