Healthcare Provider Details

I. General information

NPI: 1922126473
Provider Name (Legal Business Name): DAVID EARL HOEKENGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 PUEBLO VIS
LAS CRUCES NM
88007-8905
US

IV. Provider business mailing address

PO BOX 237
EL RITO NM
87530-0237
US

V. Phone/Fax

Practice location:
  • Phone: 505-522-2936
  • Fax: 505-522-2592
Mailing address:
  • Phone: 575-581-4728
  • Fax: 575-581-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number74-176
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: