MEDICARE: DR. KEVIN LEE HOFFARTH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A81044	CA
2	207Q00000X	Family Medicine Physician	P3000	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275530826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN LEE HOFFARTH MD

Provider Business Mailing Address
First Line	:	200 MEDICAL PKWY
Second Line	:	SUITE 310
City	:	LAKEWAY
State	:	TX
Zip	:	78738-1782
Country	:	US
Telephone Number	:	512-654-2100
Fax Number	:	512-654-2110

Provider Business Practice Location Address
First Line	:	200 MEDICAL PKWY
Second Line	:	SUITE 310
City	:	LAKEWAY
State	:	TX
Zip	:	78738-1782
Country	:	US
Telephone Number	:	512-654-2100
Fax Number	:	512-654-2110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	10/22/2012

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