DR. DOUG HODDE (NPI# 1710947957) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710947957 |
| Entity Type | Individual |
| Full Name | DR. DOUG HODDE |
| Credential | MD |
| Practice Address |
3593 E Grande Blvd Tyler TX 75707-1400 |
| Mailing Address |
Po Box 846098 Dallas TX 75284-6098 |
| Practice Telephone | 9038392585 |
| Practice Fax Number | 9035953005 |
| Mailing Telephone | 9033246450 |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2020-06-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | J2079 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | TRICARE | 75-2616977-029 | 01 |
| TX | 129731902 | 05 | |
| TX | TRICARE | 75-2616977-129 | 01 |
| TX | BCBS | 8EU189 | 01 |
| TX | TRICARE | 75-2616977-023 | 01 |
| TX | 129731906 | 05 | |
| RAILROAD MEDICARE | P01402023 | 01 |
| Street Address |
3593 E GRANDE BLVD |
| City | TYLER |
| State | TX |
| Zip Code | 75707-1400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851839120 | Trinity Clinic | Clinic/Center | 3593 E Grande Blvd, Tyler, TX 75707-1400 | 2017-02-07 |
| 1073907069 | Andrew O'kelley | Family Medicine | 3593 E Grande Blvd, Tyler, TX 75707-1400 | 2015-03-27 |
| 1508120239 | Eric Jeffrey La Voy | Family Medicine | 3593 E Grande Blvd, Tyler, TX 75707-1400 | 2012-06-27 |
| 1689823429 | Richard David Greczanik | Family Medicine | 3593 E Grande Blvd, Tyler, TX 75707-1400 | 2008-09-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063916351 | Veronica Miller | Registered Nurse | 3928 Mobley Lane, Tyler, TX 75707 | 2018-03-21 |
| 1023548187 | Juan Fernando Melgoza Jr. | Specialist/Technologist | 13172 Tx-64, Tyler, TX 75707 | 2017-06-12 |
| 1396291969 | The Center At Grande, LLC | Skilled Nursing Facility | 3219 East Grande Blvd, Tyler, TX 75707 | 2016-09-01 |
| 1730432493 | Michelle Tucker | Clinic/Center | 5011 Troup Hwy Ste 100, Tyler, TX 75707 | 2012-10-18 |
| 1275724569 | Johnson Chiropractic Center | Chiropractor | 5400 University Blvd, 103, Tyler, TN 75707 | 2007-08-05 |
| 1104851096 | Raymond F Jordan | Family Medicine | 12295 Hwy. 64 E, Tyler, TX 75707 | 2006-07-11 |
| 1033514096 | David Comins Wheeler | Counselor | 5875 Grace Ave, Tyler, TX 75707-0006 | 2014-11-01 |
| 1497318968 | Haley Lynn Dominy | Licensed Vocational Nurse | 6028 Grace Ave, Tyler, TX 75707-0007 | 2019-04-19 |
| 1225591316 | Perry Flowers | Physical Therapy Assistant | 3219 E Grande Blvd, Tyler, TX 75707-1407 | 2019-04-07 |
| 1104471465 | Scott A Wright, Md | Internal Medicine | 3219 E Grande Blvd, Tyler, TX 75707-1407 | 2019-08-05 |
| Find all providers in zip 75707 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922632553 | Christina Kay Baker | Family Medicine | 2333 Dueling Oaks Dr, Tyler, TX 75703-0326 | 2020-02-21 |
| 1174155477 | Choice Supportive Care Team Inc. | Family Medicine | 4293 Kinsey Drive, Tyler, TX 75703 | 2020-02-05 |
| 1396389870 | Shelly Lynn Williams | Family Medicine | 1420 W Southwest Loop 323 Ste 100, Tyler, TX 75701-9347 | 2019-10-29 |
| 1891354494 | Beverly Diann Butler | Family Medicine | 5604 Old Bullard Rd Ste 107, Tyler, TX 75703-4359 | 2019-06-07 |
| 1851846018 | Thomas Mason Worthington Jr. | Family Medicine | 9141 Chisholm Trl, Tyler, TX 75703-0409 | 2016-08-17 |
| 1881069557 | The Bradley Clinic of Texas, Pllc | Family Medicine | 1402 Rice Rd, Suite 100, Tyler, TX 75703-3260 | 2015-12-07 |
| 1750764189 | Diabetic Renewal Center LLC | Family Medicine | 1015 Pruitt Pl Ste 105, Tyler, TX 75703-1154 | 2015-07-02 |
| 1013306273 | Pure Radiance Laser Retreat | Family Medicine | 6722 S Broadway Ave, Tyler, TX 75703-4730 | 2015-01-12 |
| 1023412988 | James Kent Gray | Family Medicine | 14843 Big Oak Bay Rd, Tyler, TX 75707-7309 | 2014-10-21 |
| 1346640182 | Morris Mht LLC | Family Medicine | 2030 Stonegate Blvd, Tyler, TX 75703-0103 | 2014-08-29 |
| Find all providers in TYLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.