Provider Demographics
NPI:1912931676
Name:HOTH, PETER L (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:HOTH
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 1:200 HAWKINS DR
Mailing Address - Street 2:FAMILY MEDICINE
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-384-7000
Mailing Address - Fax:319-467-2814
Practice Address - Street 1:920 E 2ND AVE STE 201
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2225
Practice Address - Country:US
Practice Address - Phone:319-384-7000
Practice Address - Fax:319-467-2814
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228934207Q00000X
CO45959207Q00000X, 207QS0010X
IA40778207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO020544OtherKAISER COMMERCIAL NUMBER
CO34122753Medicaid
CO34122753Medicaid