Provider Demographics
NPI:1932317518
Name:HOFFMAN, WAYNE V (HIS)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:V
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6468 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4842
Mailing Address - Country:US
Mailing Address - Phone:361-814-3487
Mailing Address - Fax:361-814-3490
Practice Address - Street 1:6468 HOLLY RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4842
Practice Address - Country:US
Practice Address - Phone:361-814-3487
Practice Address - Fax:361-814-3490
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50043237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
74-2715708OtherCORPORATE TAX ID