Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2007035010 | MO |
N | 208000000X | Pediatrician | 35-084766 | OH |
N | 2084N0402X | Child Neurologist | 2007035010 | MO |
Y | 2084N0402X | Child Neurologist | 2012-01818 | NC |
N | 2084N0402X | Child Neurologist | 35-084766 | OH |
NPI | 1003841271 |
---|---|
Provider Name | Michael David Hofmann |
First Address | Jacksonville, NC 28546-2063 |
Second Address | Jacksonville, NC 28546-5246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 16/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
204610505 | (05) | MO |