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General NPI Number Information
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NPI Number | 1366984437
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Entity Type | Organization
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Legal Business Name | GENE K. HODGES M.D.
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Dates
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Enumeration Date | 11/07/2016
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Last Update Date | 11/07/2016
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Provider Practice Location Address
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Address Line | 2065 E 17TH ST SUITE A
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8042
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Country | US
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Telephone | 208-522-3301
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Fax | 208-522-3414
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Provider Business Mailing Address
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Address Line | 2065 E 17TH ST SUITE A
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8042
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Country | US
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Telephone | 208-522-3301
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Fax | 208-522-3414
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Authorized Official
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Title or Position | BOOKKEEPER
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Name | PATRICIA C WHITE
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Credential |
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Telephone | 208-522-3301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M4937
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License Number State | ID
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