Healthcare Provider Details

I. General information

NPI: 1043897655
Provider Name (Legal Business Name): NICHOLAS HOFFMANN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

1 WYOMING ST
DAYTON OH
45409-2722
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-3882
  • Fax: 937-208-5393
Mailing address:
  • Phone: 937-208-3882
  • Fax: 937-208-5393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.018484
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number76725
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number81486
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: