Healthcare Provider Details

I. General information

NPI: 1942247010
Provider Name (Legal Business Name): BRAD R HOBBS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 MARTIN ST SUITE A
TWIN FALLS ID
83301-4591
US

IV. Provider business mailing address

206 MARTIN ST SUITE A
TWIN FALLS ID
83301-4591
US

V. Phone/Fax

Practice location:
  • Phone: 208-733-5300
  • Fax: 208-733-3015
Mailing address:
  • Phone: 208-733-5300
  • Fax: 208-733-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberM5054
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: