Healthcare Provider Details

I. General information

NPI: 1578502407
Provider Name (Legal Business Name): EDWARD RHETTSON HOBGOOD M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E FORTIFICATION ST
JACKSON MS
39202-2442
US

IV. Provider business mailing address

1325 E FORTIFICATION ST
JACKSON MS
39202-2442
US

V. Phone/Fax

Practice location:
  • Phone: 601-354-4488
  • Fax: 601-914-1845
Mailing address:
  • Phone: 601-354-4488
  • Fax: 601-914-1845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA96104
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number19772
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: