Provider Demographics
NPI:1598801441
Name:HOVANCSEK, DONALD G (DPM)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:G
Last Name:HOVANCSEK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3220
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98509-3220
Mailing Address - Country:US
Mailing Address - Phone:360-943-9600
Mailing Address - Fax:360-943-9694
Practice Address - Street 1:2828 MARTIN WAY E
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4946
Practice Address - Country:US
Practice Address - Phone:360-943-9600
Practice Address - Fax:360-943-9694
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000155213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WATO2721Medicare UPIN