Healthcare Provider Details

I. General information

NPI: 1023181294
Provider Name (Legal Business Name): CHARLES HOFFMEISTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 E DRACHMAN ST
TUCSON AZ
85719-4316
US

IV. Provider business mailing address

2104 E DRACHMAN ST
TUCSON AZ
85719-4316
US

V. Phone/Fax

Practice location:
  • Phone: 541-954-5666
  • Fax:
Mailing address:
  • Phone: 541-954-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD10093
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: