Healthcare Provider Details

I. General information

NPI: 1508868167
Provider Name (Legal Business Name): ROBERT L HOVANCSEK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBERT L HOVANCSEK D.P.M.

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2218 SIMPSON AVE
ABERDEEN WA
98520-3514
US

IV. Provider business mailing address

2218 SIMPSON AVE
ABERDEEN WA
98520-3514
US

V. Phone/Fax

Practice location:
  • Phone: 360-533-4344
  • Fax: 360-533-4755
Mailing address:
  • Phone: 360-533-4344
  • Fax: 360-533-4755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO00000531
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: