Basic Information
| Provider Information | |||||||||
| NPI: | 1669583183 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOCHHALTER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 CHAUTAUQUA BLVD | ||||||||
| Address2: | |||||||||
| City: | VALLEY CITY | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580723145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018456000 | ||||||||
| FaxNumber: | 7018456150 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 CHAUTAUQUA BLVD | ||||||||
| Address2: | |||||||||
| City: | VALLEY CITY | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580723145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018456000 | ||||||||
| FaxNumber: | 7018456150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 04/10/2013 | ||||||||
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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 | 207Q00000X | 11189 | ND | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | R-7912 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1144262858 | 05 | MN | MEDICAID | 10757 | 05 | ND | MEDICAID | 17949 | 05 | ND | MEDICAID |