MEDICARE: GREG W HOEKSEMA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician	G80685	CA

General Provider Information

NPI Number	:	1760464176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREG W HOEKSEMA MD

Provider Business Mailing Address
First Line	:	PSC 475
Second Line	:	BOX 1892
City	:	FPO
State	:	AP
Zip	:	96350
Country	:	US
Telephone Number	:	468165334
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 475
Second Line	:	BOX 1
City	:	FPO
State	:	AP
Zip	:	96350
Country	:	US
Telephone Number	:	468165334
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2005
Last Update Date	:	04/20/2008

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