Healthcare Provider Details

I. General information

NPI: 1083654107
Provider Name (Legal Business Name): JOSEPH R. HOFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MOUNTAIN VIEW DR
SHELTON WA
98584-4401
US

IV. Provider business mailing address

PO BOX 1668
SHELTON WA
98584-5001
US

V. Phone/Fax

Practice location:
  • Phone: 360-426-1611
  • Fax: 360-427-7335
Mailing address:
  • Phone: 360-426-1611
  • Fax: 360-427-7335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD00034446
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: