Provider Demographics
NPI:1184682189
Name:HOISINGTON, DOUGLAS R (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
Last Name:HOISINGTON
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 1:2600 WESTOWN PKWY STE 360
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-7306
Mailing Address - Country:US
Mailing Address - Phone:515-267-1800
Mailing Address - Fax:515-267-8857
Practice Address - Street 1:2600 WESTOWN PKWY STE 360
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-7306
Practice Address - Country:US
Practice Address - Phone:515-267-1800
Practice Address - Fax:515-267-8857
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02226207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2036863Medicaid
IA49533Medicare PIN
A03502Medicare UPIN