Provider Demographics
NPI:1275513301
Name:HOCH, DOUGLAS W (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:W
Last Name:HOCH
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:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IA
Mailing Address - Zip Code:50060-0365
Mailing Address - Country:US
Mailing Address - Phone:641-872-2063
Mailing Address - Fax:641-872-2070
Practice Address - Street 1:417 S. EAST ST.
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IA
Practice Address - Zip Code:50060-1860
Practice Address - Country:US
Practice Address - Phone:641-872-2063
Practice Address - Fax:641-872-2070
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20625207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA40860OtherBCBS
IA40861OtherBCBS
IA080109585OtherRR MEDICARE
IA6150664Medicaid
IA7150664Medicaid
IA40860OtherBCBS
IA6150664Medicaid
IA7150664Medicaid