Provider Demographics
NPI:1063471746
Name:HODGE, DAVID S (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:HODGE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6235 N FRESNO ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5269
Mailing Address - Country:US
Mailing Address - Phone:559-440-9740
Mailing Address - Fax:559-440-9771
Practice Address - Street 1:215 N FRESNO ST
Practice Address - Street 2:SUITE 370
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721
Practice Address - Country:US
Practice Address - Phone:559-440-9740
Practice Address - Fax:559-440-9771
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG393252086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47784Medicare UPIN
CA00G393250Medicare ID - Type Unspecified