Provider Demographics
NPI:1598823288
Name:HODGSON, STEVE (RPT)
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:
Last Name:HODGSON
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2968 ROCKVIEW PL
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6772
Mailing Address - Country:US
Mailing Address - Phone:805-305-3273
Mailing Address - Fax:
Practice Address - Street 1:2968 ROCKVIEW PL
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6772
Practice Address - Country:US
Practice Address - Phone:805-305-3273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28027208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT28027OtherBLUE CROSS
CAOPT28027OtherBLUE SHIELD
CAGPT001411Medicaid
CAPT28027OtherBLUE CROSS