Provider Demographics
NPI:1720404882
Name:WALLACE R HODGES MD LLC
Entity Type:Organization
Organization Name:WALLACE R HODGES MD LLC
Other - Org Name:BETTER INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-467-1457
Mailing Address - Street 1:901 BOREN AVE
Mailing Address - Street 2:STE 615
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3595
Mailing Address - Country:US
Mailing Address - Phone:206-467-1457
Mailing Address - Fax:206-467-1347
Practice Address - Street 1:901 BOREN AVE
Practice Address - Street 2:STE 615
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3595
Practice Address - Country:US
Practice Address - Phone:206-467-1457
Practice Address - Fax:206-467-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty