Healthcare Provider Details

I. General information

NPI: 1750500773
Provider Name (Legal Business Name): RICHARD T HOBACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 SPRINGBORO WEST
DAYTON OH
45439
US

IV. Provider business mailing address

2023 SPRINGBORO WEST
DAYTON OH
45439
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-7770
  • Fax: 937-293-9982
Mailing address:
  • Phone: 937-293-7770
  • Fax: 937-293-9982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35029236
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: