Individual
JACK M. HOFFNUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 MEDICAL PARK BLVD, BRISTOL, TN 37620-7430
(423) 968-1144
(423) 968-3453
Mailing address
3053 W STATE ST, BRISTOL, TN 37620-1720
(423) 968-1144
(423) 968-3453
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
15316
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0216840000
—
WV
01
—
242045
ANTHEM BCBS
VA
01
—
3058534
BCBS
TN
05
—
3193230
—
TN
05
—
64927460
—
KY
05
—
7213395
—
VA
01
—
R07104
JOHN DEERE
TN
Enumeration date
08/09/2005
Last updated
03/12/2010
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