Healthcare Provider Details

I. General information

NPI: 1528040631
Provider Name (Legal Business Name): MOLLY HOEFLICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 NE HOYT ST SUITE 353
PORTLAND OR
97213-2991
US

IV. Provider business mailing address

PO BOX 821350
VANCOUVER WA
98682-0030
US

V. Phone/Fax

Practice location:
  • Phone: 503-230-2833
  • Fax: 503-232-8223
Mailing address:
  • Phone: 503-283-5220
  • Fax: 503-283-4527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD14908
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: