Provider Demographics
NPI:1194045252
Name:HOFFMAN, GARY FRANKLIN (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:FRANKLIN
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 1529
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-1529
Mailing Address - Country:US
Mailing Address - Phone:208-725-5522
Mailing Address - Fax:208-725-5522
Practice Address - Street 1:235 SPUR LANE
Practice Address - Street 2:202
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340-1529
Practice Address - Country:US
Practice Address - Phone:208-725-5522
Practice Address - Fax:208-725-5522
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5780208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics