Healthcare Provider Details

I. General information

NPI: 1942648225
Provider Name (Legal Business Name): PHILIP JOHN HOFFMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 E 5TH ST STE 208
WASHINGTON MO
63090-3129
US

IV. Provider business mailing address

851 E 5TH ST STE 208
WASHINGTON MO
63090-3129
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-8097
  • Fax:
Mailing address:
  • Phone: 636-239-8097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number2019045767
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number78396
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: