Provider Demographics
NPI:1316900921
Name:HOFFMANN JANISCH, JULIE (DO)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:HOFFMANN JANISCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MERCY WAY
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4524
Mailing Address - Country:US
Mailing Address - Phone:417-781-2727
Mailing Address - Fax:417-208-3625
Practice Address - Street 1:100 MERCY WAY
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-781-2727
Practice Address - Fax:417-208-3625
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005032729207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ110231924OtherRR MEDICARE
MOP00297190OtherRR MEDICARE
MO208326009Medicaid
AZ515885Medicaid
AZAZ0710370OtherBC/BS OF AZ
MO205413OtherBCBS
MO937494817Medicare ID - Type Unspecified
AZAZ0710370OtherBC/BS OF AZ
AZ102144Medicare PIN
AZ102110Medicare PIN
AZH16478Medicare UPIN
AZ515885Medicaid