Healthcare Provider Details

I. General information

NPI: 1467590174
Provider Name (Legal Business Name): RICHARD D HOBSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 S PONDEROSA ST
PAYSON AZ
85541-5542
US

IV. Provider business mailing address

PO BOX 15070
SCOTTSDALE AZ
85267-5070
US

V. Phone/Fax

Practice location:
  • Phone: 602-386-9982
  • Fax: 484-231-9982
Mailing address:
  • Phone: 480-421-9700
  • Fax: 480-421-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4761300-1206
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2360
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: