Healthcare Provider Details

I. General information

NPI: 1871679878
Provider Name (Legal Business Name): DAVID HOFHEINS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E MAIN ST
OTHELLO WA
99344
US

IV. Provider business mailing address

140 E MAIN ST
OTHELLO WA
99344
US

V. Phone/Fax

Practice location:
  • Phone: 509-488-5256
  • Fax: 509-488-9939
Mailing address:
  • Phone: 509-488-5256
  • Fax: 509-488-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00000824
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: