Healthcare Provider Details

I. General information

NPI: 1104825827
Provider Name (Legal Business Name): JOHN H HOHENGARTEN III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 BRYANT WILLIAMS DRIVE STE 200
KLAMATH FALLS OR
97601
US

IV. Provider business mailing address

3000 BRYANT WILLIAMS DRIVE STE 200
KLAMATH FALLS OR
97601
US

V. Phone/Fax

Practice location:
  • Phone: 541-274-3000
  • Fax: 541-274-2305
Mailing address:
  • Phone: 541-274-3000
  • Fax: 541-274-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number19274
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD29336
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: