Healthcare Provider Details

I. General information

NPI: 1508818568
Provider Name (Legal Business Name): DARREL HOTMIRE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 HARMON RD
BLUFFTON OH
45817-1069
US

IV. Provider business mailing address

226 LOCUST COURT
BLUFFTON OH
45817-8534
US

V. Phone/Fax

Practice location:
  • Phone: 419-369-4804
  • Fax: 419-369-4805
Mailing address:
  • Phone: 419-369-4804
  • Fax: 419-369-4805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34006384
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: