Provider Demographics
NPI:1013996875
Name:HOTH, JOELLEN M (MD)
Entity Type:Individual
Prefix:
First Name:JOELLEN
Middle Name:M
Last Name:HOTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-5227
Mailing Address - Country:US
Mailing Address - Phone:319-753-1619
Mailing Address - Fax:319-753-1170
Practice Address - Street 1:515 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-5227
Practice Address - Country:US
Practice Address - Phone:319-753-1619
Practice Address - Fax:319-753-1170
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0014787Medicaid
IA01478OtherBLUE SHIELD
IAA14155Medicare UPIN
IA01478Medicare PIN