Provider Demographics
NPI:1891784393
Name:HODGES, DAVID SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
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 1:6900 PECOS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-4400
Mailing Address - Country:US
Mailing Address - Phone:702-791-9000
Mailing Address - Fax:
Practice Address - Street 1:6900 PECOS RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:702-791-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5176207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80921ZOtherHMO BLUE
TX85E561OtherBC/BS
TX134952407Medicaid
NM52538OtherPRESBYTERIAN COMMERCIAL
TX115226100OtherFIRSTCARE COMMERCIAL
TX134952406Medicaid
NMF3196Medicaid
TX115226101Medicaid
NM52538Medicaid
A085OtherTRIWEST
OK100154150AMedicaid
A085OtherTRIWEST
TX100010825Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TX115226101Medicaid