Healthcare Provider Details

I. General information

NPI: 1295970457
Provider Name (Legal Business Name): MARVIN J. HOFFERT, MD, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 N 115TH ST STE 207
SEATTLE WA
98133-8411
US

IV. Provider business mailing address

1530 N 115TH ST STE 207
SEATTLE WA
98133-8411
US

V. Phone/Fax

Practice location:
  • Phone: 206-523-7246
  • Fax:
Mailing address:
  • Phone: 206-523-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD00035635
License Number StateWA

VIII. Authorized Official

Name: DR. MARVIN J. HOFFERT
Title or Position: OWNER, DIRECTOR
Credential: MD
Phone: 206-523-7246