Healthcare Provider Details

I. General information

NPI: 1447235965
Provider Name (Legal Business Name): GAYLORD THOMAS HOFFERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 OLMSTED BLVD STE 7
PINEHURST NC
28374-9191
US

IV. Provider business mailing address

293 OLMSTED BLVD STE 7
PINEHURST NC
28374-9191
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-3344
  • Fax: 910-295-3165
Mailing address:
  • Phone: 910-295-3344
  • Fax: 910-295-3165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number28721
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number04-48303
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number264798
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number74120
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number236787
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD2019-0048
License Number StateNM

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: