Provider Demographics
NPI:1609895481
Name:HOFFMAN, JAMES E (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:DO
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 843225
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3225
Mailing Address - Country:US
Mailing Address - Phone:708-633-1234
Mailing Address - Fax:708-342-7100
Practice Address - Street 1:3250 GORDONVILLE RD
Practice Address - Street 2:STE 301
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5056
Practice Address - Country:US
Practice Address - Phone:573-334-9641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7B50208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
138966OtherHEALTHLINK
MO603528OtherANTHEM BCBS
IL1609895481Medicaid
MO241599216Medicaid
MOF14831Medicare UPIN
IL1609895481Medicaid
MO020010653Medicare PIN