Provider Demographics
NPI:1588865091
Name:HENTZELMAN, JOSHUA L (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:L
Last Name:HENTZELMAN
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 1:1008 S SPRING AVE # 3300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2520
Mailing Address - Country:US
Mailing Address - Phone:314-977-8884
Mailing Address - Fax:
Practice Address - Street 1:1225 S GRAND BLVD DEPT OF
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-977-5110
Practice Address - Fax:314-977-7686
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2010029569207YS0012X, 207YS0123X, 207YX0901X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology