Healthcare Provider Details

I. General information

NPI: 1063650117
Provider Name (Legal Business Name): JOHN DOUGLAS HOFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 WELLINGTON WAY
FORT SMITH AR
72908-9057
US

IV. Provider business mailing address

9800 WELLINGTON WAY
FORT SMITH AR
72908-9057
US

V. Phone/Fax

Practice location:
  • Phone: 479-646-8444
  • Fax:
Mailing address:
  • Phone: 479-646-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR-2494
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: