Healthcare Provider Details

I. General information

NPI: 1417952300
Provider Name (Legal Business Name): ELIOT BRIAN HOFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13411 PARKER COMMONS BLVD SUITE 101
FORT MYERS FL
33912-4335
US

IV. Provider business mailing address

13411 PARKER COMMONS BLVD SUITE 101
FORT MYERS FL
33912-4335
US

V. Phone/Fax

Practice location:
  • Phone: 239-415-4900
  • Fax: 239-337-4901
Mailing address:
  • Phone: 239-415-4900
  • Fax: 239-337-4901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME50742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: