Healthcare Provider Details

I. General information

NPI: 1518965649
Provider Name (Legal Business Name): JOHN LOUIS HOFFMAN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11819 109TH CT
SEMINOLE FL
33778-3656
US

IV. Provider business mailing address

PO BOX 4162
SEMINOLE FL
33775-4162
US

V. Phone/Fax

Practice location:
  • Phone: 727-422-7655
  • Fax: 727-395-0207
Mailing address:
  • Phone: 727-422-7655
  • Fax: 727-395-0207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO 2199
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: