Healthcare Provider Details

I. General information

NPI: 1316984057
Provider Name (Legal Business Name): MARY R HOFFMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 01/04/2025
Certification Date: 01/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 4TH ST
SPRINGFIELD IL
62702-5238
US

IV. Provider business mailing address

520 N 4TH ST PO BOX 19670
SPRINGFIELD IL
62702-5238
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-747-1351
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-747-1351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036110636
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-110636
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: