Healthcare Provider Details

I. General information

NPI: 1316055320
Provider Name (Legal Business Name): GENE K. HODGES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 E 17TH ST SUITE A
IDAHO FALLS ID
83404-8042
US

IV. Provider business mailing address

2065 E 17TH ST STE A
IDAHO FALLS ID
83404-8042
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-3301
  • Fax: 208-522-3414
Mailing address:
  • Phone: 208-522-3301
  • Fax: 208-522-3414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM4937
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberM4937
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberM4937
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: