Provider Demographics
NPI:1326147034
Name:HOFHEINS, BRYAN BERNELL (PA)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:BERNELL
Last Name:HOFHEINS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:703 STRAWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-5695
Mailing Address - Country:US
Mailing Address - Phone:435-632-2845
Mailing Address - Fax:801-429-0629
Practice Address - Street 1:1055 N 500 W STE 102
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3305
Practice Address - Country:US
Practice Address - Phone:385-203-1107
Practice Address - Fax:801-429-0629
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT378238-1206363AM0700X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine