Provider Demographics
NPI:1134115652
Name:HEZMALL, HOWARD PATTERSON (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:PATTERSON
Last Name:HEZMALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 ANGLERS DR STE 202
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8841
Mailing Address - Country:US
Mailing Address - Phone:970-871-9710
Mailing Address - Fax:970-871-9709
Practice Address - Street 1:501 ANGLERS DR STE 202
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8841
Practice Address - Country:US
Practice Address - Phone:970-871-9710
Practice Address - Fax:970-871-9709
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1642208800000X
CO45214208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042790801Medicaid
TX135373207Medicaid
TX042790801Medicaid
TXC16885Medicare UPIN
TX83Z607Medicare PIN