Healthcare Provider Details

I. General information

NPI: 1386615557
Provider Name (Legal Business Name): ROY ALLEN HOFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 5TH ST BLDG 840
DAYTON OH
45433-7951
US

IV. Provider business mailing address

220 HOVEY RD
PENSACOLA FL
32508-1044
US

V. Phone/Fax

Practice location:
  • Phone: 937-938-2703
  • Fax:
Mailing address:
  • Phone: 757-675-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number0101235655
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101235655
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: