Individual
DR. CHARLES RUSSELL HOFFMAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4003 KRESGE WAY, SUITE 400, LOUISVILLE, KY 40207-4652
(502) 895-4263
(502) 899-5488
Mailing address
PO BOX 950248, LOUISVILLE, KY 40295-0248
(502) 253-1035
(502) 253-1037
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
20669
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000047114
ANTHEM BLUE PLANS
KY
01
—
1114911039
RAILROAD MEDICARE
KY
05
—
50005575
—
KY
01
—
6109684127212
ANTHEM SENIOR ADVANTAGE
KY
05
—
64206691
—
KY
Enumeration date
09/07/2005
Last updated
08/27/2014
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