Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | G39325 | CA |
NPI | 1063471746 |
---|---|
Provider Name | David S. Hodge |
First Address | Fresno, CA 93710-5269 |
Second Address | Fresno, CA 93721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 19/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A47784 | (02) | CA |