Healthcare Provider Details

I. General information

NPI: 1891770111
Provider Name (Legal Business Name): JOHN DAVID HOFBAUER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N BEDFORD DR #300
BEVERLY HILLS CA
90210-4322
US

IV. Provider business mailing address

416 N. BEDFORD DR. #300
BEVERLY HILLS CA
90210
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-2333
  • Fax: 310-273-6583
Mailing address:
  • Phone: 310-273-2333
  • Fax: 310-273-6583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG38645
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: