Individual
DR. MARK J HOFFMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11615 OLIVE BLVD, SAINT LOUIS, MO 63141-7095
(314) 993-9555
Mailing address
11615 OLIVE BLVD, SAINT LOUIS, MO 63141-7095
(314) 993-9555
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
036063458
IL
2085R0202X
Diagnostic Radiology Physician
Primary
R3B51
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036063458
—
IL
05
—
202110300
—
MO
01
—
300102471
RAILROAD MEDICARE
MO
01
—
300102474
RAILROAD MEDICARE
MO
Enumeration date
07/21/2006
Last updated
10/14/2011
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