Provider Demographics
NPI:1154347409
Name:HOFFMAN, PHILLIP H (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:H
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 910670
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0670
Mailing Address - Country:US
Mailing Address - Phone:859-971-4685
Mailing Address - Fax:859-971-4602
Practice Address - Street 1:100 PROVIDENCE WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-6031
Practice Address - Country:US
Practice Address - Phone:859-260-5370
Practice Address - Fax:859-260-5379
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64194053Medicaid
KYK080990Medicare PIN
C64391Medicare UPIN