Healthcare Provider Details

I. General information

NPI: 1003966045
Provider Name (Legal Business Name): MICHAEL R HOBAUGH MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 OAKRIDGE DR., STE 100 PEDIATRIC ASSOCIATES OF NORTHERN COLORADO
FORT COLLINS CO
80525
US

IV. Provider business mailing address

1330 OAKRIDGE DR., STE 100 PEDIATRIC ASSOCIATES OF NORTHERN COLORADO
FORT COLLINS CO
80525
US

V. Phone/Fax

Practice location:
  • Phone: 970-484-4871
  • Fax: 970-482-4927
Mailing address:
  • Phone: 970-484-4871
  • Fax: 970-482-4927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0056036
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036106127
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: