Provider Demographics
NPI:1982749834
Name:HOFMANN, GLEN E (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:E
Last Name:HOFMANN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7095 CLYO ROAD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459
Mailing Address - Country:US
Mailing Address - Phone:937-458-5084
Mailing Address - Fax:937-458-5089
Practice Address - Street 1:7095 CLYO ROAD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-458-5084
Practice Address - Fax:937-458-5089
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-0680207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology