Provider Demographics
NPI:1295970457
Name:MARVIN J. HOFFERT, MD, PS
Entity type:Organization
Organization Name:MARVIN J. HOFFERT, MD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOFFERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-523-7246
Mailing Address - Street 1:1530 N 115TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8411
Mailing Address - Country:US
Mailing Address - Phone:206-523-7246
Mailing Address - Fax:
Practice Address - Street 1:1530 N 115TH ST STE 207
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8411
Practice Address - Country:US
Practice Address - Phone:206-523-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035635261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1103043Medicaid
WA117818OtherLABOR & INDUSTRIES
WA117818OtherLABOR & INDUSTRIES