Provider Demographics
NPI:1134278609
Name:DODD, RENEE HOLLAS (PA-C)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:HOLLAS
Last Name:DODD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23960 KATY FWY STE 140
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0892
Mailing Address - Country:US
Mailing Address - Phone:134-649-9397
Mailing Address - Fax:134-649-9427
Practice Address - Street 1:23960 KATY FWY STE 140
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-0892
Practice Address - Country:US
Practice Address - Phone:713-464-9939
Practice Address - Fax:713-464-9942
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03798363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ36188Medicare UPIN