Provider Demographics
NPI:1265480552
Name:HOFFMAN, MICHAEL D (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9991 MARSH LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-1766
Mailing Address - Country:US
Mailing Address - Phone:214-358-0090
Mailing Address - Fax:214-526-6851
Practice Address - Street 1:9991 MARSH LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-1709
Practice Address - Country:US
Practice Address - Phone:214-358-0090
Practice Address - Fax:214-526-6851
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135113210Medicaid
TX135113207Medicaid
TX135113212Medicaid
TX135113211Medicaid
TX87V820Medicare ID - Type UnspecifiedFAM MEDICAL OF NORTH DALL
TX135113211Medicaid
TX135113210Medicaid
D97402Medicare UPIN
TX8720B9Medicare ID - Type UnspecifiedHIGHWAY 30 FAM MED