Healthcare Provider Details

I. General information

NPI: 1154347409
Provider Name (Legal Business Name): PHILLIP H. HOFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PROVIDENCE WAY SUITE 200
NICHOLASVILLE KY
40356-6031
US

IV. Provider business mailing address

PO BOX 910670
LEXINGTON KY
40591-0670
US

V. Phone/Fax

Practice location:
  • Phone: 859-260-5370
  • Fax: 859-260-5379
Mailing address:
  • Phone: 859-971-4685
  • Fax: 859-971-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19405
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: