Provider Demographics
NPI:1225177835
Name:ALAN L. HOFFMANN, M. D.
Entity Type:Organization
Organization Name:ALAN L. HOFFMANN, M. D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:HOFFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-353-1191
Mailing Address - Street 1:6300 EVANSTON AVE
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-4930
Mailing Address - Country:US
Mailing Address - Phone:816-353-1191
Mailing Address - Fax:816-353-1193
Practice Address - Street 1:6300 EVANSTON AVE
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-4930
Practice Address - Country:US
Practice Address - Phone:816-353-1191
Practice Address - Fax:816-353-1193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3755261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC50210Medicare UPIN