Healthcare Provider Details

I. General information

NPI: 1003443821
Provider Name (Legal Business Name): SAMUEL AUGUSTUS HOFACKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 ERWIN RD
DURHAM NC
27710-0001
US

IV. Provider business mailing address

40 DUKE MEDICINE CIRCLE BOX 3534
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-681-8263
  • Fax:
Mailing address:
  • Phone: 919-681-8263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2024-00669
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: