Basic Information
| Provider Information | |||||||||
| NPI: | 1841287679 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOFFMAN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 101 CABARRUS AVE E | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280253699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888497379 | ||||||||
| FaxNumber: | 8558577333 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 CABARRUS AVE E | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280253699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888497379 | ||||||||
| FaxNumber: | 8558577333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 12/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/18/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 80607 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME137348 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | E-11497 | AR | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 52136 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0101265646 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 35.134060 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 4301114941 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | D0085354 | MD | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 58776 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 39821 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | NC2348 | 05 | SC | MEDICAID | 894278B | 05 | NC | MEDICAID | 1841287679 | 05 | NC | MEDICAID |