Provider Demographics
NPI:1710091251
Name:HOEKSTRA, GREGORY L (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:HOEKSTRA
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 1:1015 S HACKETT RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-3500
Mailing Address - Country:US
Mailing Address - Phone:319-274-1000
Mailing Address - Fax:319-292-6526
Practice Address - Street 1:1015 S HACKETT RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-3500
Practice Address - Country:US
Practice Address - Phone:319-274-1000
Practice Address - Fax:319-292-6526
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01585174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1710091251Medicaid
IAP00758400OtherRR MEDICARE
IA1097592Medicaid
IA1710091251Medicaid
IA719260108Medicare PIN
IA1097592Medicaid