Healthcare Provider Details

I. General information

NPI: 1790917771
Provider Name (Legal Business Name): ERNEST NATHANIEL HOFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 SAN PEDRO AVE
TALLAHASSEE FL
32304-1341
US

IV. Provider business mailing address

2306 SAN PEDRO AVE
TALLAHASSEE FL
32304-1341
US

V. Phone/Fax

Practice location:
  • Phone: 850-576-5184
  • Fax:
Mailing address:
  • Phone: 850-576-5184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME47177
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: