Provider Demographics
NPI:1225027253
Name:HODGES, TIMOTHY P (DO FAMILY PRACTICE)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:P
Last Name:HODGES
Suffix:
Gender:M
Credentials:DO FAMILY PRACTICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191050
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-1050
Mailing Address - Country:US
Mailing Address - Phone:208-955-6500
Mailing Address - Fax:208-955-6501
Practice Address - Street 1:6052 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-2739
Practice Address - Country:US
Practice Address - Phone:208-955-6500
Practice Address - Fax:208-955-6501
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1295140648Medicaid
ID20005021Medicare PIN
F31443Medicare UPIN
ID000010002591OtherBCBS
ID080081154OtherRR MEDICARE
ID32417OtherBCBS
ID806359000OtherHEALTHY CONNECTIONS
F31443Medicare UPIN