Provider Demographics
NPI:1306862594
Name:HILTZ, DOUGLAS K (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:K
Last Name:HILTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10922
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-0922
Mailing Address - Country:US
Mailing Address - Phone:910-457-9127
Mailing Address - Fax:910-269-2884
Practice Address - Street 1:1513 N HOWE ST
Practice Address - Street 2:UNIT 6
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-2769
Practice Address - Country:US
Practice Address - Phone:910-457-9127
Practice Address - Fax:910-269-2884
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33376207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904153Medicaid
NC5904153Medicaid
NC213747FMedicare ID - Type Unspecified