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NPI Code Detail

MEDICARE: MR. TIMOTHY P HODGES DO. FAMILY PRACTICE

MEDICARE: MR. TIMOTHY P HODGES DO. FAMILY PRACTICE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician0109ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225027253
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TIMOTHY P HODGES DO. FAMILY PRACTICE
Provider Business Mailing Address
First Line : PO BOX 191050
Second Line :
City : BOISE
State : ID
Zip : 83719-1050
Country : US
Telephone Number : 208-955-6500
Fax Number : 208-955-6501
Provider Business Practice Location Address
First Line : 6052 W STATE ST
Second Line :
City : BOISE
State : ID
Zip : 83703-2739
Country : US
Telephone Number : 208-955-6500
Fax Number : 208-955-6501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 12/28/2023

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