=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568464220
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT D. HOFFMAN D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2005
-----------------------------------------------------
Last Update Date | 10/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 307 E SCENIC VALLEY AVE
-----------------------------------------------------
City | INDIANOLA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50125-4865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-961-8448
-----------------------------------------------------
Fax | 515-643-9100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1475
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50305-1475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-961-8448
-----------------------------------------------------
Fax | 515-643-9100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 3461
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------