Individual
DR. STEPHANIE LOIS KODACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1110 N SARAH DEWITT DR, GONZALES, TX 78629-3311
(830) 672-8502
(830) 672-3035
Mailing address
1110 N SARAH DEWITT DR, GONZALES, TX 78629-3311
(830) 672-8502
(830) 672-3035
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0349045-01
—
TX
Enumeration date
03/28/2006
Last updated
11/12/2013
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