Provider Demographics
NPI:1053325605
Name:HOEFLICKER, CODY B (DO)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:B
Last Name:HOEFLICKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:525 BRANSON LANDING BLVD STE 201A
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2052
Practice Address - Country:US
Practice Address - Phone:417-335-7128
Practice Address - Fax:417-348-8007
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2006008750207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201725801Medicaid
P00358378OtherRAILROAD MEDICARE
250766OtherHEALTHLINK