Provider Demographics
NPI:1427123066
Name:HOFFMAN, LEANNA MARIE (MD)
Entity type:Individual
Prefix:
First Name:LEANNA
Middle Name:MARIE
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 STATE HWY 564
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301
Mailing Address - Country:US
Mailing Address - Phone:505-722-7234
Mailing Address - Fax:505-863-6078
Practice Address - Street 1:520 NM HIGHWAY 564
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4873
Practice Address - Country:US
Practice Address - Phone:505-722-7234
Practice Address - Fax:505-863-6078
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-9403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine