Provider Demographics
NPI:1154303832
Name:HOCKMUTH, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:HOCKMUTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5880 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8220
Mailing Address - Country:US
Mailing Address - Phone:515-633-3835
Mailing Address - Fax:515-633-3837
Practice Address - Street 1:411 LAUREL ST
Practice Address - Street 2:SUITE A250
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3017
Practice Address - Country:US
Practice Address - Phone:515-235-5000
Practice Address - Fax:515-288-6713
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2016-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA28766208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0084590Medicaid
IA0084590Medicaid
IA11829Medicare ID - Type Unspecified