Healthcare Provider Details

I. General information

NPI: 1205006897
Provider Name (Legal Business Name): DANIEL MORSE HOFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 15TH AVE W STE 102
WILLISTON ND
58801-3800
US

IV. Provider business mailing address

PO BOX 2010
FARGO ND
58122-2484
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-8860
  • Fax: 701-234-8924
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number170293
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number55291-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberDR.0058256
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number15286
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: