Basic Information
| Provider Information | |||||||||
| NPI: | 1295970457 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MARVIN J. HOFFERT, MD, PS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1530 N 115TH ST STE 207 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981338411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065237246 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1530 N 115TH ST STE 207 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981338411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065237246 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2008 | ||||||||
| LastUpdateDate: | 01/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | HOFFERT | ||||||||
| AuthorizedOfficialFirstName: | MARVIN | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2065237246 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | MD00035635 | WA | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
ID Information
| ID | Type | State | Issuer | Description | 1103043 | 05 | WA | MEDICAID | 117818 | 01 | WA | LABOR & INDUSTRIES | OTHER |