Provider Demographics
NPI:1285683417
Name:HOEFELMANN, RICHARD WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WALTER
Last Name:HOEFELMANN
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 1:100 E HUBBARD ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-5320
Mailing Address - Country:US
Mailing Address - Phone:940-325-0743
Mailing Address - Fax:940-325-9617
Practice Address - Street 1:100 E HUBBARD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-5320
Practice Address - Country:US
Practice Address - Phone:940-325-0743
Practice Address - Fax:940-325-9617
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7783174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114410702Medicaid
TX0D64QMedicare ID - Type Unspecified
TX0A0090Medicare PIN