Provider Demographics
NPI:1891739975
Name:HOFFMAN, GRAHAM WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:WALTER
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 1:319 S LAIRD DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-2736
Mailing Address - Country:US
Mailing Address - Phone:719-647-9569
Mailing Address - Fax:
Practice Address - Street 1:SAN CARLOS CORRECTIONAL FACILITY
Practice Address - Street 2:1410 W. 13TH STREET
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003
Practice Address - Country:US
Practice Address - Phone:719-544-4800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO293782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry