Healthcare Provider Details

I. General information

NPI: 1639498777
Provider Name (Legal Business Name): BRADLEY HOFF PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 5TH ST N
CARRINGTON ND
58421
US

IV. Provider business mailing address

820 5TH ST N PO BOX 79
CARRINGTON ND
58421-1223
US

V. Phone/Fax

Practice location:
  • Phone: 701-652-2515
  • Fax: 701-652-2846
Mailing address:
  • Phone: 701-652-2515
  • Fax: 701-652-2846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAC0423
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: