Provider Demographics
NPI:1508818568
Name:HOTMIRE, DARREL (DO)
Entity Type:Individual
Prefix:
First Name:DARREL
Middle Name:
Last Name:HOTMIRE
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 1:226 LOCUST COURT
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:OH
Mailing Address - Zip Code:45817-8534
Mailing Address - Country:US
Mailing Address - Phone:419-369-4804
Mailing Address - Fax:419-369-4805
Practice Address - Street 1:582 HARMON RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817-1069
Practice Address - Country:US
Practice Address - Phone:419-369-4804
Practice Address - Fax:419-369-4805
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH343310OtherANTHEM
OHP00182718OtherRAILROAD MEDICARE
OH2116203Medicaid
OH5797708OtherAETNA
OH$$$$$$$$$00OtherBUREAU OF WORKER'S COMP
OHP00182718OtherRAILROAD MEDICARE
OH$$$$$$$$$012OtherMEDICAL MUTUAL
OH343310OtherANTHEM