Provider Demographics
NPI:1790917771
Name:HOFFMAN, ERNEST NATHANIEL (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:NATHANIEL
Last Name:HOFFMAN
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 1:2306 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-1341
Mailing Address - Country:US
Mailing Address - Phone:850-576-5184
Mailing Address - Fax:
Practice Address - Street 1:2306 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-1341
Practice Address - Country:US
Practice Address - Phone:850-576-5184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47177208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice