Healthcare Provider Details

I. General information

NPI: 1356333074
Provider Name (Legal Business Name): GARY LEROY HOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 GRAND AVE
DES MOINES IA
50312-4104
US

IV. Provider business mailing address

3200 GRAND AVE
DES MOINES IA
50312-4104
US

V. Phone/Fax

Practice location:
  • Phone: 515-471-9243
  • Fax: 515-471-9319
Mailing address:
  • Phone: 515-471-9243
  • Fax: 515-471-9319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number01963
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: