Provider Demographics
NPI:1114932506
Name:HOOFFSTETTER, JUDITH B (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:B
Last Name:HOOFFSTETTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9412 BEAR MOUNTAIN TRL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1335
Mailing Address - Country:US
Mailing Address - Phone:505-856-7209
Mailing Address - Fax:
Practice Address - Street 1:9412 BEAR MOUNTAIN TRL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1335
Practice Address - Country:US
Practice Address - Phone:505-856-7209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97322207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEG68473Medicare UPIN