Healthcare Provider Details

I. General information

NPI: 1124019112
Provider Name (Legal Business Name): WALTER JAY HOFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WELLINGTON AVE STE A
GRAND JUNCTION CO
81501-8180
US

IV. Provider business mailing address

3900 E MEXICO AVE STE 102
DENVER CO
80210-3940
US

V. Phone/Fax

Practice location:
  • Phone: 720-524-1001
  • Fax: 720-524-1121
Mailing address:
  • Phone: 720-524-1001
  • Fax: 970-256-9149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number41908
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: