Healthcare Provider Details

I. General information

NPI: 1801239868
Provider Name (Legal Business Name): MAKARY THOMAS HOFMANN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NE NEFF RD
BEND OR
97701-6015
US

IV. Provider business mailing address

2865 DAGGETT AVE SKY LAKES MEDICAL CENTER - ADMINISTRATIVE OFFICE
KLAMATH FALLS OR
97601-1106
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-5811
  • Fax: 541-706-5867
Mailing address:
  • Phone: 541-274-6101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDO178718
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: