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General NPI Number Information
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NPI Number | 1063757482
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Entity Type | Organization
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Legal Business Name | MARK C. HOFMANN, M.D., P.A.
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 2968 RAINBOW RD
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2435
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Country | US
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Telephone | 904-636-5919
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Fax | 904-636-9043
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Provider Business Mailing Address
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Address Line | 2968 RAINBOW RD
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2435
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Country | US
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Telephone | 904-636-5919
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Fax | 904-636-9043
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK CHARLES HOFMANN
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Credential | M.D.
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Telephone | 904-636-5919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 059601
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License Number State | FL
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