Provider Demographics
NPI:1275530826
Name:HOFFARTH, KEVIN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEE
Last Name:HOFFARTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 MEDICAL PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78738-1782
Mailing Address - Country:US
Mailing Address - Phone:512-654-2100
Mailing Address - Fax:512-654-2110
Practice Address - Street 1:200 MEDICAL PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78738-1782
Practice Address - Country:US
Practice Address - Phone:512-654-2100
Practice Address - Fax:512-654-2110
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA81044207Q00000X
TXP3000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A810440Medicaid
NV100508905Medicaid
NV100508675Medicaid
TXTXB161488Medicare UPIN
H53174Medicare UPIN
CA00A810440Medicaid