Provider Demographics
NPI:1497062558
Name:HOFTIEZER, PETER KENNETH (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:KENNETH
Last Name:HOFTIEZER
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 1:1200 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARITON
Mailing Address - State:IA
Mailing Address - Zip Code:50049-1210
Mailing Address - Country:US
Mailing Address - Phone:641-774-8103
Mailing Address - Fax:641-727-8087
Practice Address - Street 1:1200 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHARITON
Practice Address - State:IA
Practice Address - Zip Code:50049
Practice Address - Country:US
Practice Address - Phone:641-774-8103
Practice Address - Fax:641-774-8087
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010024515207Q00000X
IA4453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4453OtherLICENSE