Provider Demographics
NPI:1568494631
Name:HODGKISS, THOMAS D (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:HODGKISS
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 1:5683 S REX RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3821
Mailing Address - Country:US
Mailing Address - Phone:901-350-0678
Mailing Address - Fax:901-350-0677
Practice Address - Street 1:5683 S REX RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3821
Practice Address - Country:US
Practice Address - Phone:901-350-0678
Practice Address - Fax:901-350-0677
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS130602085R0202X
ARR43172085R0202X
TN208012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115815Medicaid
AR126458001Medicaid
TN4004657OtherBCBS TN
TN3054578Medicaid
AR96979OtherBCBS AR
MO207729021Medicaid
4615497OtherAETNA
AR126458001Medicaid
TN300118453Medicare PIN
4615497OtherAETNA
MO207729021Medicaid
TN3054578Medicare PIN