Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 01050312A | IN |
Y | 208600000X | Surgeon | 01050312A | IN |
N | 2086X0206X | Surgical Oncologist | 01050312A | IN |
NPI | 1205806361 |
---|---|
Provider Name | Dr. Richard B Hostetter |
First Address | Fort Wayne, IN 46845-1703 |
Second Address | Lagrange, IN 46761-1325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 31/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200218420 | (05) | IN |
F82055 | (02) | IN |