Healthcare Provider Details

I. General information

NPI: 1871886226
Provider Name (Legal Business Name): IRWIN HOFFMAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 GARCIA ST
SANTA FE NM
87505-2858
US

IV. Provider business mailing address

646 GARCIA ST
SANTA FE NM
87505-2858
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-1854
  • Fax: 505-989-6478
Mailing address:
  • Phone: 505-984-1854
  • Fax: 505-989-6478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number76-194
License Number StateNM

VIII. Authorized Official

Name: IRWIN HOFFMAN
Title or Position: OWNER
Credential: MD
Phone: 505-984-1854