Provider Demographics
NPI:1003819640
Name:HOSTETTER, HEBER PEART III (DO)
Entity Type:Individual
Prefix:DR
First Name:HEBER
Middle Name:PEART
Last Name:HOSTETTER
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 S STATE ST REET
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2200
Mailing Address - Country:US
Mailing Address - Phone:614-882-2349
Mailing Address - Fax:614-882-9005
Practice Address - Street 1:190 S STATE STREET
Practice Address - Street 2:SUITE A
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2200
Practice Address - Country:US
Practice Address - Phone:614-882-2349
Practice Address - Fax:614-882-9005
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:2005-06-01
Deactivation Code:
Reactivation Date:2005-07-06
Provider Licenses
StateLicense IDTaxonomies
OH34-003329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0695494Medicaid
OH34-003329OtherSTATE LICENSE
OHHO0533523OtherUPIN#
OH34-003329OtherSTATE LICENSE
OHD89770Medicare UPIN