Provider Demographics
NPI:1437124450
Name:HOFER, DARRELL R (MD)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:R
Last Name:HOFER
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 1:3807 S MADISON ST
Mailing Address - Street 2:PO BOX 1676
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47302-5758
Mailing Address - Country:US
Mailing Address - Phone:765-213-3707
Mailing Address - Fax:765-751-3313
Practice Address - Street 1:3807 S MADISON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302-5758
Practice Address - Country:US
Practice Address - Phone:765-751-3300
Practice Address - Fax:765-751-3313
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027075A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000343302OtherANTHEM BCBS
IN100347440Medicaid
IN100347440AMedicaid
INE03700Medicare UPIN
IN000000343302OtherANTHEM BCBS
IN466980UMedicare Oscar/Certification