Provider Demographics
NPI:1942247010
Name:HOBBS, BRAD R (MD)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:R
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 1:206 MARTIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4591
Mailing Address - Country:US
Mailing Address - Phone:208-733-5300
Mailing Address - Fax:208-733-3015
Practice Address - Street 1:206 MARTIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4591
Practice Address - Country:US
Practice Address - Phone:208-733-5300
Practice Address - Fax:208-733-3015
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5054174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist