Healthcare Provider Details

I. General information

NPI: 1063725695
Provider Name (Legal Business Name): KYLE HOEDEBECKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2010
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 IRISH RD
SAGLE ID
83860-5031
US

IV. Provider business mailing address

31014 TIMBER BEND LN
SPRING TX
77386-4400
US

V. Phone/Fax

Practice location:
  • Phone: 307-284-3227
  • Fax:
Mailing address:
  • Phone: 409-218-3296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number167601
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU0489
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: