Provider Demographics
NPI:1063757482
Name:MARK C. HOFMANN, M.D., P.A.
Entity type:Organization
Organization Name:MARK C. HOFMANN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HOFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-636-5919
Mailing Address - Street 1:2968 RAINBOW RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2435
Mailing Address - Country:US
Mailing Address - Phone:904-636-5919
Mailing Address - Fax:904-636-9043
Practice Address - Street 1:2968 RAINBOW RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2435
Practice Address - Country:US
Practice Address - Phone:904-636-5919
Practice Address - Fax:904-636-9043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL059601208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12477AMedicare UPIN