MEDICARE: EUGENE HOXTELL M.D.

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	207ND0900X	Dermatopathology Physician	2120	SD

General Provider Information

NPI Number	:	1811311590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE HOXTELL M.D.

Provider Business Mailing Address
First Line	:	4605 S OXBOW AVE APT 204
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-4134
Country	:	US
Telephone Number	:	605-261-3632
Fax Number	:

Provider Business Practice Location Address
First Line	:	4605 S OXBOW AVE APT 204
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-4134
Country	:	US
Telephone Number	:	605-261-3632
Fax Number	:

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

Provider Enumeration Date	:	02/14/2014
Last Update Date	:	02/14/2014

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