Provider Demographics
NPI:1134414725
Name:HODGES, LEISA LACOMBE (DO)
Entity type:Individual
Prefix:DR
First Name:LEISA
Middle Name:LACOMBE
Last Name:HODGES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:VERNA
Other - Middle Name:LEISA
Other - Last Name:HODGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4471 LONG PRAIRIE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1795
Mailing Address - Country:US
Mailing Address - Phone:972-316-4555
Mailing Address - Fax:
Practice Address - Street 1:152 BRAND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094
Practice Address - Country:US
Practice Address - Phone:972-316-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3692207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology