Provider Demographics
NPI:1124646112
Name:DAVID S HODGE MD INC
Entity type:Organization
Organization Name:DAVID S HODGE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STANTON
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-440-9740
Mailing Address - Street 1:180 W BULLARD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0998
Mailing Address - Country:US
Mailing Address - Phone:559-440-9740
Mailing Address - Fax:
Practice Address - Street 1:215 NORTH FRESNO STREET, SUITE 370
Practice Address - Street 2:SUITE 370
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-0998
Practice Address - Country:US
Practice Address - Phone:559-495-4543
Practice Address - Fax:559-459-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty