Provider Demographics
NPI:1558477745
Name:HINTZ, BRENT MATTHEW (MD)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:MATTHEW
Last Name:HINTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W DALE ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1951
Mailing Address - Country:US
Mailing Address - Phone:319-235-3865
Mailing Address - Fax:319-235-3873
Practice Address - Street 1:212 WEST DALE ST.
Practice Address - Street 2:SUITE 402
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703
Practice Address - Country:US
Practice Address - Phone:319-235-3865
Practice Address - Fax:319-235-3873
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23079207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0046805Medicaid
IA27330Medicare ID - Type Unspecified
IA0046805Medicaid