Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | M4937 | ID |
NPI | 1316055320 |
---|---|
Provider Name | Dr. Gene K. Hodges |
First Address | Idaho Falls, ID 83404-8042 |
Second Address | Idaho Falls, ID 83404-8042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 18/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000316100 | (05) | ID |
1117710 | MEDICARE (01) | ID |
B63719 | (02) | ID |