Healthcare Provider Details

I. General information

NPI: 1134115652
Provider Name (Legal Business Name): HOWARD PATTERSON HEZMALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ANGLERS DR STE 202
STEAMBOAT SPRINGS CO
80487-8841
US

IV. Provider business mailing address

501 ANGLERS DR STE 202
STEAMBOAT SPRINGS CO
80487-8841
US

V. Phone/Fax

Practice location:
  • Phone: 970-871-9710
  • Fax: 970-871-9709
Mailing address:
  • Phone: 970-871-9710
  • Fax: 970-871-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberF1642
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number45214
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: