Provider Demographics
NPI:1487186490
Name:HOCQUARD, KYLE WILLS (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:WILLS
Last Name:HOCQUARD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:510 BOREN AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5501
Practice Address - Country:US
Practice Address - Phone:206-320-5200
Practice Address - Fax:206-320-5202
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD61045443207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1487186490Medicaid