Active NPI
Stephanie Lois Kodack, M.D.
- Specialist
- Gonzales, TX
National Provider Identifier
1326009671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Practice address
- 1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311 - Phone
- (830) 672-8502
- Fax
- (830) 672-3035
- NPI assigned
- Mar 28, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | TX | Primary |
Addresses
Primary practice location
1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311
Mailing address
1110 N Sarah Dewitt Dr
Gonzales, TX 78629-3311
Phone (830) 672-8502
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0349045-01 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384214400000",
"number": "1326009671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1110 N SARAH DEWITT DR",
"city": "GONZALES",
"state": "TX",
"postal_code": "786293311",
"telephone_number": "830-672-8502",
"fax_number": "830-672-3035"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 N SARAH DEWITT DR",
"city": "GONZALES",
"state": "TX",
"postal_code": "786293311",
"telephone_number": "830-672-8502",
"fax_number": "830-672-3035"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KODACK",
"first_name": "STEPHANIE",
"middle_name": "LOIS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-28",
"last_updated": "2013-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "TX",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0349045-01",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gonzales, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.