Individual
ROBERT DAVID HODSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
220 BANNOCK ST, MALAD CITY, ID 83252-1256
(208) 766-2600
Mailing address
150 N 200 W, MALAD CITY, ID 83252-1239
(208) 766-2231
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
O-0380
ID
207Q00000X
Family Medicine Physician
Primary
O-1077
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1252901
GROUP
ID
Enumeration date
05/11/2006
Last updated
09/29/2021
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