Healthcare Provider Details

I. General information

NPI: 1730170069
Provider Name (Legal Business Name): ROGER HOFFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 PETERS CREEK RD NW
ROANOKE VA
24017-2500
US

IV. Provider business mailing address

836 PENDLETON DR
SALEM VA
24153-2662
US

V. Phone/Fax

Practice location:
  • Phone: 540-562-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101-033345
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: