Healthcare Provider Details

I. General information

NPI: 1407296080
Provider Name (Legal Business Name): JEFFREY DAVID HOEKSMA M.D., BSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 VAN BUREN RD
CARIBOU ME
04736-3567
US

IV. Provider business mailing address

163 VAN BUREN RD PO BOX 40
CARIBOU ME
04736-3567
US

V. Phone/Fax

Practice location:
  • Phone: 207-498-3111
  • Fax: 207-498-3947
Mailing address:
  • Phone: 207-498-3111
  • Fax: 207-498-3947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD20941
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: