Provider Demographics
NPI:1447235965
Name:HOFFERT, GAYLORD THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:GAYLORD
Middle Name:THOMAS
Last Name:HOFFERT
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:PO BOX 2340
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11969-2340
Mailing Address - Country:US
Mailing Address - Phone:631-283-2100
Mailing Address - Fax:631-283-5731
Practice Address - Street 1:325 MEETING HOUSE LN
Practice Address - Street 2:BUILDING #2 SUITE 403
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5087
Practice Address - Country:US
Practice Address - Phone:631-283-2100
Practice Address - Fax:631-283-5731
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2019-0048207RN0300X
NY236787207RN0300X
KS04-48303207RN0300X
WV28721207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7X2551Medicare ID - Type Unspecified
I41841Medicare UPIN