Healthcare Provider Details

I. General information

NPI: 1013996875
Provider Name (Legal Business Name): JOELLEN M. HOTH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N 3RD ST
BURLINGTON IA
52601-5227
US

IV. Provider business mailing address

515 N 3RD ST
BURLINGTON IA
52601-5227
US

V. Phone/Fax

Practice location:
  • Phone: 319-753-1619
  • Fax: 319-753-1170
Mailing address:
  • Phone: 319-753-1619
  • Fax: 319-753-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17292
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: