Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 12009020A | IN |
NPI | 1033112099 |
---|---|
Provider Name | John Jeffrey Hockema |
First Address | Fishers, IN 46038-2637 |
Second Address | Zionsville, IN 46077-8782 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 27/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100318460 | (05) | IN |
U317778 | (02) | IN |