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Blake Allen Hoerdeman

Surgery

Allopathic & Osteopathic Physicians

1638 Owen Dr, Fayetteville, NC 28304-3424

PECOS Enrollment

This provider is enrolled in PECOS as BLAKE HOERDEMAN.

Based on the most recent information from CMS, provider Blake Allen Hoerdeman is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 6 days ago.

Profile Details

Provider ID
1992362420
Provider Type
Individual
Full Name
Hoerdeman, Blake Allen
Credential
DO

Gender
Male
Sole Proprietor
No
Enumeration Date
5/21/2019
Last Updated
9/8/2025

Contact Information

Practice Location

1638 Owen Dr, Fayetteville, NC 28304-3424

(910) 615-5095

Unlisted Fax

Mailing Location

1638 Owen Dr, Fayetteville, NC 28304-3424

(910) 615-5095

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 208600000X Primary	Description Surgery Allopathic & Osteopathic Physicians	License 2025-01816 North Carolina
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Blake Allen Hoerdeman

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Carolina Surgical Specialists, Pa

Mccullough, Daniel Grant

Horowitz, Joel I

Schultz, Susan

Faillace, Deon F

Freitas, Jenna

Owen Drive Surgical Clinic Of Fayetteville Pllc

Igwilo, Obinna Chukwudi

Albrecht, Robert Joseph

Lewis, Kenneth Bryant