Basic Information
| Provider Information | |||||||||
| NPI: | 1366440984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOERMAN | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 407 | ||||||||
| Address2: | |||||||||
| City: | VIDALIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304750407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125374986 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1811 EDWINA DR | ||||||||
| Address2: | |||||||||
| City: | VIDALIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304748963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125388105 | ||||||||
| FaxNumber: | 9125388109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 10/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 070272 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 070272 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 2849327 | 01 | AETNA | OTHER | P55286567 | 01 | MULTIPLAN | OTHER | 71847 | 01 | GHI HMO | OTHER | 003138585A | 05 | GA | MEDICAID | P2017338 | 01 | OXFORD | OTHER | 2K1057 | 01 | HEALTHNET | OTHER |