Provider Demographics
NPI:1548308653
Name:HODGE, NICOLE C (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:C
Last Name:HODGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5001 SPRING VALLEY RD
Mailing Address - Street 2:SUITE 400 EAST
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3946
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 COMMERCE ST STE 514
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75202-4522
Practice Address - Country:US
Practice Address - Phone:972-637-8456
Practice Address - Fax:469-405-8612
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7272207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology