Provider Demographics
NPI:1477506814
Name:WALLING, HOBART W (MD)
Entity Type:Individual
Prefix:
First Name:HOBART
Middle Name:W
Last Name:WALLING
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 1:1100 6TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1755
Mailing Address - Country:US
Mailing Address - Phone:319-337-4566
Mailing Address - Fax:319-337-4766
Practice Address - Street 1:1100 6TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1755
Practice Address - Country:US
Practice Address - Phone:319-337-4566
Practice Address - Fax:319-337-4766
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35094207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI11551OtherMEDICARE GROUP
IA19-52331605OtherNPI GROUP
IA0466557Medicaid
IAI20222Medicare PIN
IAI11551OtherMEDICARE GROUP