Individual
NICHOLAS W. HODGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4424 E FLAMINGO AVE, STE 300, NAMPA, ID 83687
(208) 302-0200
(208) 302-0255
Mailing address
3340 E GOLDSTONE DR, MERIDIAN, ID 83642
(208) 302-0200
(208) 302-0255
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
38352
IA
207RI0011X
Interventional Cardiology Physician
Primary
M-14705
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71960
MEDICARE GROUP
—
01
—
CA3899
RR MEDICARE GROUP
—
01
—
POO731202
RR MEDICARE INDIV
—
Enumeration date
08/03/2006
Last updated
07/23/2019
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