Healthcare Provider Details

I. General information

NPI: 1699000562
Provider Name (Legal Business Name): MARIO R HOFHEINZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2009
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 WILDWOOD AVE SUITE 105
SHERWOOD AR
72120-5089
US

IV. Provider business mailing address

705 SANTA FE DR SUITE 105
SEARCY AR
72143-6964
US

V. Phone/Fax

Practice location:
  • Phone: 501-833-3833
  • Fax: 501-833-8191
Mailing address:
  • Phone: 501-833-3833
  • Fax: 501-833-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberP-T0932
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-395
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: