Provider Demographics
NPI:1417931890
Name:HOFFA, GEOFFREY W (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:W
Last Name:HOFFA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 W CAREFREE HWY
Mailing Address - Street 2:SUITE 1, PMB# 529
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3201
Mailing Address - Country:US
Mailing Address - Phone:480-268-0561
Mailing Address - Fax:480-323-2617
Practice Address - Street 1:3120 W CAREFREE HWY
Practice Address - Street 2:SUITE 1, PMB# 529
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85086-3201
Practice Address - Country:US
Practice Address - Phone:480-268-0561
Practice Address - Fax:480-323-2617
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2396363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ702870Medicaid
AZ702870Medicaid
AZZ70579Medicare PIN