Provider Demographics
NPI:1942220967
Name:HOFFMANN, RUSSELL G (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:G
Last Name:HOFFMANN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8888 LADUE RD
Mailing Address - Street 2:#120
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2056
Mailing Address - Country:US
Mailing Address - Phone:314-454-6069
Mailing Address - Fax:314-726-6069
Practice Address - Street 1:8888 LADUE RD
Practice Address - Street 2:#120
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2056
Practice Address - Country:US
Practice Address - Phone:314-454-6069
Practice Address - Fax:314-726-6069
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01819103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
137664OtherBCBS
6154245OtherUBH