Basic Information
| Provider Information | |||||||||
| NPI: | 1487145629 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOVLAND | ||||||||
| FirstName: | MARK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 621 S ILLINOIS AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | MASON CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504015489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414283041 | ||||||||
| FaxNumber: | 6414283059 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 22ND AVE | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535661569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083242000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2018 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R-11198 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 75516 | WI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.