Healthcare Provider Details

I. General information

NPI: 1184128795
Provider Name (Legal Business Name): JASON JAMES HOFSTEDE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88TH MEDICAL GROUP 4881 SUGAR MAPLE DR.
WPAFB OH
45433
US

IV. Provider business mailing address

88TH MEDICAL GROUP 4881 SUGAR MAPLE DR.
WPAFB OH
45433
US

V. Phone/Fax

Practice location:
  • Phone: 937-522-2778
  • Fax:
Mailing address:
  • Phone: 937-522-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.018152
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02005924A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: