Provider Demographics
NPI:1831133040
Name:HOELTING, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:HOELTING
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:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:PENDER
Mailing Address - State:NE
Mailing Address - Zip Code:68047-0100
Mailing Address - Country:US
Mailing Address - Phone:402-385-4004
Mailing Address - Fax:402-385-4041
Practice Address - Street 1:958 WELLNESS WAY STE 1
Practice Address - Street 2:
Practice Address - City:PENDER
Practice Address - State:NE
Practice Address - Zip Code:68047-4518
Practice Address - Country:US
Practice Address - Phone:402-385-3033
Practice Address - Fax:402-385-3092
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE90761OtherWELLMARK BCBS IA
NE00437OtherBCBS NE
IA0914838Medicaid
NE42128384911Medicaid
NE42128384921 - BANCROMedicaid
A01291Medicare UPIN
NE42128384921 - BANCROMedicaid