Provider Demographics
NPI:1760464176
Name:HOEKSEMA, GREG W (MD)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:W
Last Name:HOEKSEMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 475
Mailing Address - Street 2:BOX 1892
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96350
Mailing Address - Country:US
Mailing Address - Phone:46-816-5334
Mailing Address - Fax:
Practice Address - Street 1:PSC 475
Practice Address - Street 2:BOX 1
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96350
Practice Address - Country:US
Practice Address - Phone:46-816-5334
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80685207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine