Provider Demographics
NPI:1518946094
Name:HOFFMAN, THEODORE FREDERICK JR (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:FREDERICK
Last Name:HOFFMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TED
Other - Middle Name:
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2817 REILLY ROAD
Mailing Address - Street 2:WOMACK ARMY CETNER MCXC-COD CREDENTIALS
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:REILLY ROAD
Practice Address - Street 2:WOMACK ARMY MEDICAL CENTER FORT BRAGG OPERATING ROOM
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:910-907-7668
Practice Address - Fax:910-907-8015
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24973207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC24159OtherBCBS
NC8942915Medicaid
NC8942915Medicaid