Provider Demographics
NPI:1386605475
Name:HOKE, WALLACE S (MD)
Entity type:Individual
Prefix:
First Name:WALLACE
Middle Name:S
Last Name:HOKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2205 W PARKER RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-7778
Mailing Address - Country:US
Mailing Address - Phone:870-933-9250
Mailing Address - Fax:870-931-4790
Practice Address - Street 1:2205 W PARKER RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-7778
Practice Address - Country:US
Practice Address - Phone:870-933-9250
Practice Address - Fax:870-931-4790
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-7291207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR115018001Medicaid
AR115018001Medicaid
ARB90308Medicare UPIN