Provider Demographics
NPI:1043774359
Name:HOFFMAN, JOHN CONOR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CONOR
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 E 10TH ST APT 532
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-0823
Mailing Address - Country:US
Mailing Address - Phone:919-630-6942
Mailing Address - Fax:
Practice Address - Street 1:3535 E 10TH ST APT 532
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-0823
Practice Address - Country:US
Practice Address - Phone:919-630-6942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-3558207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine