Provider Demographics
NPI:1124019112
Name:HOFFMAN, WALTER JAY (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:JAY
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 1:3900 E MEXICO AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3940
Mailing Address - Country:US
Mailing Address - Phone:720-524-1001
Mailing Address - Fax:970-256-9149
Practice Address - Street 1:1000 WELLINGTON AVE
Practice Address - Street 2:STE A
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8180
Practice Address - Country:US
Practice Address - Phone:720-524-1001
Practice Address - Fax:720-524-1121
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41908207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC800548Medicare PIN
CO72424818Medicaid
CO59007231Medicaid
C92876Medicare UPIN
COC800742Medicare PIN