Healthcare Provider Details

I. General information

NPI: 1588651749
Provider Name (Legal Business Name): KURT HOFMANN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 PARK AVE
IRONTON OH
45638-1596
US

IV. Provider business mailing address

PO BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 740-534-0021
  • Fax: 740-534-0029
Mailing address:
  • Phone: 606-408-6200
  • Fax: 606-408-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-005262
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: