Basic Information
| Provider Information | |||||||||
| NPI: | 1548244718 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOFFMANN | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | ARTHUR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2315 8TH ST | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 835017301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087461383 | ||||||||
| FaxNumber: | 2087466348 | ||||||||
| Practice Location | |||||||||
| Address1: | 2315 8TH ST | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 835017301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087461383 | ||||||||
| FaxNumber: | 2087466348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 0101265993 | VA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 048241 | GA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD60061899 | WA | N | Allopathic & Osteopathic Physicians | Surgery | 208C00000X | 0101265993 | VA | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208600000X | M10571 | ID | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1548244718 | 01 | ID | REGENCE BLUESHIELD | OTHER | 77796 | 01 | ID | BC/ID | OTHER | 1548244718 | 05 | ID | MEDICAID | 2001383 | 05 | WA | MEDICAID | 0244969 | 01 | WA | LABOR & INDUSTRIES | OTHER | P00717410 | 01 | ID | RR MEDICARE | OTHER |