Provider Demographics
NPI:1447225685
Name:HOFFMAN, REBECCA (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14508 NE 20TH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6434
Mailing Address - Country:US
Mailing Address - Phone:360-574-9730
Mailing Address - Fax:360-576-7662
Practice Address - Street 1:14508 NE 20TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6424
Practice Address - Country:US
Practice Address - Phone:360-574-9730
Practice Address - Fax:360-576-7662
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1116367Medicaid
WAAB32170Medicare PIN
WA1116367Medicaid