Provider Demographics
NPI:1750470704
Name:HODGE, BRADLEY G (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:G
Last Name:HODGE
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 1:1906 W US HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-6893
Mailing Address - Country:US
Mailing Address - Phone:903-892-8398
Mailing Address - Fax:903-892-6665
Practice Address - Street 1:1906 W US HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-6893
Practice Address - Country:US
Practice Address - Phone:903-892-8398
Practice Address - Fax:903-892-6665
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK67VOtherMEDICARE/BLUESHIELD GROUP
TXK67VOtherMEDICARE/BLUESHIELD GROUP
TX80V534Medicare ID - Type Unspecified