Provider Demographics
NPI:1821365842
Name:PATRICK L. HODGES, M.D., PA
Entity Type:Organization
Organization Name:PATRICK L. HODGES, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-739-5760
Mailing Address - Street 1:8220 WALNUT HILL LANE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4406
Mailing Address - Country:US
Mailing Address - Phone:214-739-5760
Mailing Address - Fax:214-739-5966
Practice Address - Street 1:8220 WALNUT HILL LANE
Practice Address - Street 2:SUITE 206
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4406
Practice Address - Country:US
Practice Address - Phone:214-739-5760
Practice Address - Fax:214-739-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4409208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00FG92Medicare PIN
TXC16987Medicare UPIN