Healthcare Provider Details

I. General information

NPI: 1740455302
Provider Name (Legal Business Name): LARRY WAYNE HOFF PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DAVID GRANT USAF MEDICAL CENTER'S MCCLELLAN OUTPATIENT 5342 DUDLEY BLVD
MCCLELLAN PARK CA
95652
US

IV. Provider business mailing address

DAVID GRANT USAF MEDICAL CENTER'S MCCLELLAN OUTPATIENT 5342 DUDLEY BLVD
MCCLELLAN CA
95652-1012
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110009789
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: