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General NPI Number Information
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NPI Number | 1184128795
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Entity Type | Individual
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Provider Name | JASON JAMES HOFSTEDE DO
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Gender | Male
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 88TH MEDICAL GROUP 4881 SUGAR MAPLE DR.
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City | WPAFB
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State | OH
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Zip | 45433
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Country | US
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Telephone | 937-522-2778
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Fax |
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Provider Business Mailing Address
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Address Line | 88TH MEDICAL GROUP 4881 SUGAR MAPLE DR.
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City | WPAFB
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State | OH
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Zip | 45433
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Country | US
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Telephone | 937-522-2778
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 34.018152
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02005924A
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License Number State | IN
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