Provider Demographics
NPI:1033122072
Name:CARREON, HIJINIO G (DO)
Entity Type:Individual
Prefix:
First Name:HIJINIO
Middle Name:G
Last Name:CARREON
Suffix:
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:PO BOX 4925
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50306-4925
Mailing Address - Country:US
Mailing Address - Phone:515-643-4973
Mailing Address - Fax:515-643-2784
Practice Address - Street 1:1111 6TH AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2610
Practice Address - Country:US
Practice Address - Phone:515-247-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-03811207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114525Medicaid
800810OtherMEDICARE GROUP NO.
K26398Medicare ID - Type Unspecified