Provider Demographics
NPI:1578663043
Name:SHOFF, DENNIS GERALD (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:GERALD
Last Name:SHOFF
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 1:1310 WOODLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701
Mailing Address - Country:US
Mailing Address - Phone:270-765-6141
Mailing Address - Fax:270-765-6141
Practice Address - Street 1:1310 WOODLAND DRIVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-765-6141
Practice Address - Fax:270-765-6141
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20718207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2435204000OtherPASSPORT ADVANTAGE
000000062512OtherANTHEM
0096702Medicare ID - Type Unspecified
000000062512OtherANTHEM