Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 28766 | IA |
NPI | 1154303832 |
---|---|
Provider Name | David R Hockmuth |
First Address | West Des Moines, IA 50266-8220 |
Second Address | Des Moines, IA 50314-3017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 25/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0084590 | (05) | IA |
E68646 | (02) | IA |