Healthcare Provider Details

I. General information

NPI: 1306205778
Provider Name (Legal Business Name): DEBORAH HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

547 SW 7TH ST
NEWPORT OR
97365-4909
US

IV. Provider business mailing address

5192 SALMON RIVER HWY
NEOTSU OR
97364
US

V. Phone/Fax

Practice location:
  • Phone: 541-574-9570
  • Fax: 541-574-8857
Mailing address:
  • Phone: 541-574-9570
  • Fax: 541-574-8857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number13-06-30
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: