Individual
WALLACE R HODGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
901 BOREN AVE, STE 615, SEATTLE, WA 98104-3595
(206) 467-1457
(206) 467-1347
Mailing address
901 BOREN AVE, STE 615, SEATTLE, WA 98104-3595
(206) 467-1457
(206) 467-1347
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00015517
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110022931
RR MEDICARE
WA
05
—
1805407
—
WA
01
—
78926
LE
WA
Enumeration date
10/11/2005
Last updated
03/25/2014
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