Healthcare Provider Details

I. General information

NPI: 1285635763
Provider Name (Legal Business Name): BRADFORD V HOFFMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GLENN HENDREN DR
LIBERTY MO
64068-9625
US

IV. Provider business mailing address

PO BOX 411375
KANSAS CITY MO
64141-1375
US

V. Phone/Fax

Practice location:
  • Phone: 816-792-7000
  • Fax:
Mailing address:
  • Phone: 816-781-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2001007765
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: