Healthcare Provider Details

I. General information

NPI: 1730178708
Provider Name (Legal Business Name): ERNEST J HOEFNER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 BERNARD DRIVE SUITE 201
ROANOKE VA
24018-4327
US

IV. Provider business mailing address

PO BOX 36840
ALBUQUERQUE NM
87176-6840
US

V. Phone/Fax

Practice location:
  • Phone: 540-345-0289
  • Fax: 540-345-9569
Mailing address:
  • Phone: 505-243-7729
  • Fax: 505-243-4804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA1272-04
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0102205460
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: