Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 44201 | WI |
N | 207Q00000X | Family Doctor | 4765 | AZ |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 65756 | MN |
NPI | 1104871607 |
---|---|
Provider Name | Dr. Maria Hoertz |
First Address | Maricopa, AZ 85139-2926 |
Second Address | Marshall, MN 56258-1934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 25/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H62774 | (02) | MS |