Healthcare Provider Details

I. General information

NPI: 1154469435
Provider Name (Legal Business Name): RONALD LLOYD HOFELDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 FAIRVIEW AVE SE
SALEM OR
97302-2534
US

IV. Provider business mailing address

PO BOX 3939
SALEM OR
97302-0939
US

V. Phone/Fax

Practice location:
  • Phone: 503-399-7093
  • Fax:
Mailing address:
  • Phone: 503-399-7093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD10326
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: