Healthcare Provider Details

I. General information

NPI: 1144586918
Provider Name (Legal Business Name): JOHN D MAYERHOFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SIXTH AVE N
ST CLOUD MN
56303-2735
US

IV. Provider business mailing address

1200 SIXTH AVE N
ST CLOUD MN
56303-2735
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-2700
  • Fax: 612-904-4358
Mailing address:
  • Phone: 320-251-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number108273
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: