Provider Demographics
NPI:1760459788
Name:HOFFMANN, SUSAN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEE
Last Name:HOFFMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7645 MERRILL RD STE 301
Practice Address - Street 2:UFJP MERRILL RD FAMILY MEDICINE
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-6575
Practice Address - Country:US
Practice Address - Phone:904-633-0285
Practice Address - Fax:904-633-0286
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000674704AMedicaid
FL0352292-00Medicaid
FL45039XMedicare PIN
FL0352292-00Medicaid
FLF28699Medicare UPIN