Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 34-003329 | OH |
NPI | 1003819640 |
---|---|
Provider Name | Dr. Heber Peart Hostetter III |
First Address | Westerville, OH 43081-2200 |
Second Address | Westerville, OH 43081-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0695494 | (05) | OH |
34-003329 | STATE LICENSE (01) | OH |
D89770 | (02) | OH |
HO0533523 | UPIN# (01) | OH |