Provider Demographics
NPI:1003815119
Name:HOFFMEISTER, MARC A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:A
Last Name:HOFFMEISTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 CR 4600
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-7540
Mailing Address - Country:US
Mailing Address - Phone:620-331-4772
Mailing Address - Fax:
Practice Address - Street 1:116 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:CHERRYVALE
Practice Address - State:KS
Practice Address - Zip Code:67335-1729
Practice Address - Country:US
Practice Address - Phone:620-336-3244
Practice Address - Fax:620-336-3755
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00335363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant