MEDICARE: DR. RICHARD T HOBACK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician	35029236	OH

General Provider Information

NPI Number	:	1750500773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD T HOBACK MD

Provider Business Mailing Address
First Line	:	2023 SPRINGBORO WEST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45439
Country	:	US
Telephone Number	:	937-293-7770
Fax Number	:	937-293-9982

Provider Business Practice Location Address
First Line	:	2023 SPRINGBORO WEST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45439
Country	:	US
Telephone Number	:	937-293-7770
Fax Number	:	937-293-9982

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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