Healthcare Provider Details

I. General information

NPI: 1063471746
Provider Name (Legal Business Name): DAVID S. HODGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N FRESNO ST SUITE 370
FRESNO CA
93721
US

IV. Provider business mailing address

6235 N FRESNO ST SUITE 106
FRESNO CA
93710-5269
US

V. Phone/Fax

Practice location:
  • Phone: 559-440-9740
  • Fax: 559-440-9771
Mailing address:
  • Phone: 559-440-9740
  • Fax: 559-440-9771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberG39325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: