Provider Demographics
NPI:1861498503
Name:HOFFMAN, JOHN GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GREGORY
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J.
Other - Middle Name:GREGORY
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2730 SW WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8338
Mailing Address - Country:US
Mailing Address - Phone:817-916-5180
Mailing Address - Fax:817-916-5199
Practice Address - Street 1:2730 SW WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8338
Practice Address - Country:US
Practice Address - Phone:817-916-5180
Practice Address - Fax:817-916-5199
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5557207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044929001Medicaid
TX044929002Medicaid
TX044929003Medicaid
TX044929004Medicaid
TX8L22748Medicare PIN
TX8L22749Medicare PIN
H21339Medicare UPIN
TX8L22709Medicare PIN
TX044929003Medicaid