Healthcare Provider Details

I. General information

NPI: 1003841271
Provider Name (Legal Business Name): MICHAEL DAVID HOFMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 HENDERSON DR
JACKSONVILLE NC
28546-5246
US

IV. Provider business mailing address

PO BOX 12063
JACKSONVILLE NC
28546-2063
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-2660
  • Fax: 910-353-2770
Mailing address:
  • Phone: 910-353-2660
  • Fax: 910-353-2770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-084766
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2007035010
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number35-084766
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number2007035010
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number2012-01818
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: