Healthcare Provider Details

I. General information

NPI: 1194764811
Provider Name (Legal Business Name): JAY G. HOFFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W CENTRAL AVE
SPRINGBORO OH
45066-1106
US

IV. Provider business mailing address

360 W CENTRAL AVE
SPRINGBORO OH
45066-1106
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-7100
  • Fax: 937-208-7125
Mailing address:
  • Phone: 937-208-7100
  • Fax: 937-208-7125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.057435
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: