Provider Demographics
NPI:1316909369
Name:HEMANN, GARY THOMAS (DO)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:THOMAS
Last Name:HEMANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-2613
Mailing Address - Country:US
Mailing Address - Phone:515-247-4445
Mailing Address - Fax:515-643-8933
Practice Address - Street 1:1111 6TH AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2613
Practice Address - Country:US
Practice Address - Phone:515-247-4445
Practice Address - Fax:515-643-8933
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02232207P00000X, 207R00000X
MN42188207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAAO3750Medicare UPIN