Healthcare Provider Details

I. General information

NPI: 1144223272
Provider Name (Legal Business Name): MARK FREDERICK HOFFMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 E HARNEY ST SUITE 100
LARAMIE WY
82072-2884
US

IV. Provider business mailing address

2710 E HARNEY ST SUITE 100
LARAMIE WY
82072-2884
US

V. Phone/Fax

Practice location:
  • Phone: 307-745-8991
  • Fax: 307-745-8167
Mailing address:
  • Phone: 307-745-8991
  • Fax: 307-745-8167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberTL2023
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC158387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: