Provider Demographics
NPI:1508868167
Name:HOVANCSEK, ROBERT L (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:HOVANCSEK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:L
Other - Last Name:HOVANCSEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:2218 SIMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-3514
Mailing Address - Country:US
Mailing Address - Phone:360-533-4344
Mailing Address - Fax:360-533-4755
Practice Address - Street 1:2218 SIMPSON AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-3514
Practice Address - Country:US
Practice Address - Phone:360-533-4344
Practice Address - Fax:360-533-4755
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPO00000531213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA059467000OtherREGENCE
WA480026783OtherRAILROAD MEDICARE NUMBER
WA51866OtherL & I
WA5321381OtherAETNA
WA1089119Medicaid
WAG115000246Medicare PIN
WA1089119Medicaid
WA5321381OtherAETNA
WA480026783OtherRAILROAD MEDICARE NUMBER
U50401Medicare UPIN
WA51866OtherL & I