Provider Demographics
NPI:1386749489
Name:HOOGWERF, BYRON JAMES SR (MD)
Entity type:Individual
Prefix:DR
First Name:BYRON
Middle Name:JAMES
Last Name:HOOGWERF
Suffix:SR
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 1:8972 HUNTINGTON POINTE DR.
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-3206
Mailing Address - Country:US
Mailing Address - Phone:317-292-6387
Mailing Address - Fax:
Practice Address - Street 1:TURNING POINTS
Practice Address - Street 2:701 17TH AVE W
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205
Practice Address - Country:US
Practice Address - Phone:941-747-1509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3505246H207RE0101X
FLME137779207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0715542Medicaid
OHHO7353451Medicare PIN
OHE66514Medicare UPIN