Healthcare Provider Details

I. General information

NPI: 1679510564
Provider Name (Legal Business Name): ERIC M. HOFMANN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 N MAIN ST
MADISONVILLE KY
42431-9007
US

IV. Provider business mailing address

1851 N MAIN ST
MADISONVILLE KY
42431-9007
US

V. Phone/Fax

Practice location:
  • Phone: 270-821-0066
  • Fax: 270-821-6580
Mailing address:
  • Phone: 270-821-0066
  • Fax: 270-821-6580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA748
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: