Healthcare Provider Details

I. General information

NPI: 1649275439
Provider Name (Legal Business Name): GREGORY R HOFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 E 11400 S
SANDY UT
84094-6946
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-571-0030
  • Fax: 801-553-3196
Mailing address:
  • Phone: 801-571-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD22890
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7266855-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: