Provider Demographics
NPI:1912654179
Name:BACHOFNER, SIMON THOMAS (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:THOMAS
Last Name:BACHOFNER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 HILL ST SE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-3292
Mailing Address - Country:US
Mailing Address - Phone:541-704-7304
Mailing Address - Fax:503-296-3920
Practice Address - Street 1:1123 HILL ST SE STE B
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-3292
Practice Address - Country:US
Practice Address - Phone:541-704-7304
Practice Address - Fax:503-296-3920
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202202206NP208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics