Healthcare Provider Details

I. General information

NPI: 1124646112
Provider Name (Legal Business Name): DAVID S HODGE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 NORTH FRESNO STREET, SUITE 370 SUITE 370
FRESNO CA
93721-0998
US

IV. Provider business mailing address

180 W BULLARD AVE STE 102
CLOVIS CA
93612-0998
US

V. Phone/Fax

Practice location:
  • Phone: 559-495-4543
  • Fax: 559-459-1539
Mailing address:
  • Phone: 559-440-9740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID STANTON HODGE
Title or Position: PRESIDENT
Credential: MD
Phone: 559-440-9740