Healthcare Provider Details

I. General information

NPI: 1255345856
Provider Name (Legal Business Name): JAY THOMAS HOFFMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12805 ESCANABA DR SUITE 1
DEWITT MI
48820-8628
US

IV. Provider business mailing address

12805 ESCANABA DR SUITE 1
DEWITT MI
48820-8628
US

V. Phone/Fax

Practice location:
  • Phone: 517-975-9700
  • Fax: 517-975-9710
Mailing address:
  • Phone: 517-975-9700
  • Fax: 517-975-9710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101011137
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: