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General NPI Number Information
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NPI Number | 1982749834
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Entity Type | Individual
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Provider Name | GLEN E. HOFMANN M.D., PHD.
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 09/02/2016
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Provider Practice Location Address
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Address Line | 7095 CLYO ROAD
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City | CENTERVILLE
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State | OH
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Zip | 45459
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Country | US
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Telephone | 937-458-5084
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Fax | 937-458-5089
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Provider Business Mailing Address
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Address Line | 7095 CLYO ROAD
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City | CENTERVILLE
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State | OH
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Zip | 45459
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Country | US
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Telephone | 937-458-5084
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Fax | 937-458-5089
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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 | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 35-05-0680
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License Number State | OH
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