Healthcare Provider Details

I. General information

NPI: 1215002068
Provider Name (Legal Business Name): PHILIP J HOFSTETTER AUDIOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 FRAM STREET
PETERSBURG AK
99833
US

IV. Provider business mailing address

PO BOX 589
PETERSBURG AK
99833-0589
US

V. Phone/Fax

Practice location:
  • Phone: 907-772-4291
  • Fax: 907-772-3085
Mailing address:
  • Phone: 907-772-4291
  • Fax: 907-772-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number63
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: