Individual
DR. DOUG HODDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3593 E GRANDE BLVD, TYLER, TX 75707-1400
(903) 839-2585
(903) 595-3005
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
J2079
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129731902
—
TX
05
—
129731906
—
TX
01
—
75-2616977-023
TRICARE
TX
01
—
75-2616977-029
TRICARE
TX
01
—
75-2616977-129
TRICARE
TX
01
—
8EU189
BCBS
TX
01
—
P01402023
RAILROAD MEDICARE
—
Enumeration date
03/23/2006
Last updated
06/18/2020
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