Individual
DAVID REED HADLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
496 C SHOUP AVE W, TWIN FALLS, ID 83301-4563
(208) 735-0000
(208) 734-1717
Mailing address
496 C SHOUP AVE W, TWIN FALLS, ID 83301-4563
(208) 735-0000
(208) 734-1717
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
O-163
ID
207VE0102X
Reproductive Endocrinology Physician
O-163
ID
208D00000X
General Practice Physician
0-163
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004312000
—
ID
Enumeration date
03/14/2007
Last updated
02/06/2012
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