Individual
DR. SHANE MICHAEL HODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
102 PROFESSIONAL PARK STE C, OXFORD, NC 27565-2554
(919) 603-0368
(919) 690-0842
Mailing address
PO BOX 986, OXFORD, NC 27565-0986
(919) 690-3487
(919) 690-3246
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2011-00897
NC
208600000X
Surgery Physician
5101016839
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2335816
MEDICARE PTAN, GROUP
NC
05
—
5918846
—
NC
01
—
NC2803A
MEDICARE PTAN, INDIVIDUAL
NC
Enumeration date
06/24/2009
Last updated
10/06/2023
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