Provider Demographics
NPI:1528144771
Name:HOFFER, PHILLIP FRANKLIN (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:FRANKLIN
Last Name:HOFFER
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 2168
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37621-2168
Mailing Address - Country:US
Mailing Address - Phone:423-652-2812
Mailing Address - Fax:
Practice Address - Street 1:133 QUEENSGATE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-3041
Practice Address - Country:US
Practice Address - Phone:423-652-2812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000014540207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA138606OtherBLUE CROSS
VA005748232OtherMEDICAID
TN3043330Medicaid
TN3043330OtherBLUE CROSS
3388954Medicare ID - Type Unspecified
VA138606OtherBLUE CROSS