Healthcare Provider Details

I. General information

NPI: 1871604520
Provider Name (Legal Business Name): JOHN L HOFFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL STE 14A
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

4921 PARKVIEW PL STE 14A
SAINT LOUIS MO
63110-1032
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-8778
  • Fax:
Mailing address:
  • Phone: 314-454-8778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2002010049
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: