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Individual
DR. GLEN THEODORE HOFSTROM
Active
Individual
DR. GLEN THEODORE HOFSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD019823E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010813260001
—
PA
01
—
001793
FIRST PRIORITY HEALTH
PA
01
—
057619
HIGHMARK BLUE SHIELD
PA
01
—
1553395
UNITEDHEALTHCARE
PA
01
—
544226
AETNA
PA
01
—
B34545
HEALTHAMERICA
PA
Enumeration date
04/05/2006
Last updated
10/20/2011
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