Basic Information
| Provider Information | |||||||||
| NPI: | 1679060578 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HODGEMAN | ||||||||
| FirstName: | NICHOLAS | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3551 ROGER BROOKE DR. | ||||||||
| Address2: | MCHE-ZDM-M, INTERNAL MEDICINE RESIDENCY | ||||||||
| City: | JBSA-FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109165910 | ||||||||
| FaxNumber: | 2109162077 | ||||||||
| Practice Location | |||||||||
| Address1: | 3551 ROGER BROOKE DR. | ||||||||
| Address2: | , MCHE-ZDM-M, INTERNAL MEDICINE RESIDENCY | ||||||||
| City: | JBSA-FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109165910 | ||||||||
| FaxNumber: | 2109162077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2018 | ||||||||
| LastUpdateDate: | 04/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | 0102205994 | VA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.