Healthcare Provider Details

I. General information

NPI: 1013903285
Provider Name (Legal Business Name): DAVID RANDALL HOFIUS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MON HEALTH MEDICAL PARK DR STE 3300
MORGANTOWN WV
26505-1169
US

IV. Provider business mailing address

3000 MON HEALTH MEDICAL PARK DR STE 3300
MORGANTOWN WV
26505-1169
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-1448
  • Fax: 304-599-5335
Mailing address:
  • Phone: 304-599-1448
  • Fax: 304-599-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4165
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS008334L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: