Provider Demographics
NPI:1548244718
Name:HOFFMANN, BRIAN ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ARTHUR
Last Name:HOFFMANN
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 1:2315 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-7301
Mailing Address - Country:US
Mailing Address - Phone:208-746-1383
Mailing Address - Fax:208-746-6348
Practice Address - Street 1:2315 8TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-7301
Practice Address - Country:US
Practice Address - Phone:208-746-1383
Practice Address - Fax:208-746-6348
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101265993208600000X, 208C00000X
GA048241208600000X
WAMD60061899208600000X
IDM10571208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1548244718OtherREGENCE BLUESHIELD
ID77796OtherBC/ID
ID1548244718Medicaid
WA2001383Medicaid
WA0244969OtherLABOR & INDUSTRIES
IDP00717410OtherRR MEDICARE
WA0244969OtherLABOR & INDUSTRIES
ID1548244718Medicaid
ID1100513Medicare PIN