Provider Demographics
NPI:1760450118
Name:HOBBS, TODD M (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:M
Last Name:HOBBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 HARTWICK VILLAGE PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-3029
Mailing Address - Country:US
Mailing Address - Phone:502-643-1541
Mailing Address - Fax:
Practice Address - Street 1:4115 HARTWICK VILLAGE PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-3029
Practice Address - Country:US
Practice Address - Phone:502-643-1541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34344207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64343445Medicaid
KY000000339271OtherBC BS DDC
KY118411OtherCHA DCC
KY000000487354OtherBC BS HHC
KY000000489797OtherBC BS LPC
KY00053006Medicare ID - Type UnspecifiedAPC
KY0923101Medicare ID - Type UnspecifiedDCC
KY000000339271OtherBC BS DDC
KY000000487354OtherBC BS HHC
KY64343445Medicaid
KY000000489797OtherBC BS LPC