Provider Demographics
NPI:1265482905
Name:HODSON, ROBERT DAVID (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:HODSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N 200 W
Mailing Address - Street 2:
Mailing Address - City:MALAD CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83252-1239
Mailing Address - Country:US
Mailing Address - Phone:208-766-2231
Mailing Address - Fax:
Practice Address - Street 1:220 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:MALAD CITY
Practice Address - State:ID
Practice Address - Zip Code:83252-1256
Practice Address - Country:US
Practice Address - Phone:208-766-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-1077207Q00000X
IDO-0380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1252901OtherGROUP
ID1252901OtherGROUP
IDI54730Medicare UPIN
ID1132955Medicare Oscar/Certification