Provider Demographics
NPI:1962640276
Name:HOSTETTER, KURTIS (MD)
Entity Type:Individual
Prefix:
First Name:KURTIS
Middle Name:
Last Name:HOSTETTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3624 SIMONTON PL
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6741
Mailing Address - Country:US
Mailing Address - Phone:407-766-2804
Mailing Address - Fax:407-878-3031
Practice Address - Street 1:12303 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2640
Practice Address - Country:US
Practice Address - Phone:904-288-0277
Practice Address - Fax:904-288-0414
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME103141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine