Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 9790047-9921 | UT |
Y | 1223G0001X | General Practice | 9790047-9921 | UT |
Y | 213EG0000X | General Practice | 9790047-9921 | UT |
NPI | 1003264508 |
---|---|
Provider Name | Dr. Jameson Everett Hoffman |
First Address | Jbsa-Lackland, TX 78236-5313 |
Second Address | Jbsa-Lackland, TX 78236-5313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2016 |
Last Update Date | 03/06/2019 |