Provider Demographics
NPI:1063650117
Name:HOFFMAN, JOHN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 WELLINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-9057
Mailing Address - Country:US
Mailing Address - Phone:479-646-8444
Mailing Address - Fax:
Practice Address - Street 1:9800 WELLINGTON WAY
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-9057
Practice Address - Country:US
Practice Address - Phone:479-646-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-2494174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105774001Medicaid
ARR-2494OtherARKANSAS STATE MEDICAL LICENSE NUMBER
AR105774001Medicaid
AR52410Medicare PIN