Provider Demographics
NPI:1902862600
Name:HOEKSTRA, TIMOTHY CHARLES (MD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:CHARLES
Last Name:HOEKSTRA
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 1:1908 N 14TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2039
Mailing Address - Country:US
Mailing Address - Phone:580-718-4501
Mailing Address - Fax:580-718-4581
Practice Address - Street 1:1908 N 14TH ST STE 203
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2039
Practice Address - Country:US
Practice Address - Phone:580-718-4501
Practice Address - Fax:580-718-4581
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043481207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1420814Medicaid
MI160002638OtherMEDICARE RAILROAD
MI160002638OtherRAILROAD MEDICARE
B45471Medicare UPIN
0130029Medicare ID - Type Unspecified