Provider Demographics
NPI:1962441600
Name:HODGES, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
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 1:7005 WOODWAY DR
Mailing Address - Street 2:STE 201
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6162
Mailing Address - Country:US
Mailing Address - Phone:254-772-2222
Mailing Address - Fax:254-732-3661
Practice Address - Street 1:7005 WOODWAY DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7924
Practice Address - Country:US
Practice Address - Phone:254-776-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1071207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612310Medicare PIN
TXH28668Medicare UPIN
TX8246K4Medicare PIN