Provider Demographics
NPI:1902887813
Name:HOFMANN-SMITH, EDWIN WALTER (ND, PHD, RDMS)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:WALTER
Last Name:HOFMANN-SMITH
Suffix:
Gender:M
Credentials:ND, PHD, RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 NE 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5705
Mailing Address - Country:US
Mailing Address - Phone:503-761-2286
Mailing Address - Fax:
Practice Address - Street 1:10360 NE WASCO ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3927
Practice Address - Country:US
Practice Address - Phone:503-252-8125
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR460175F00000X
OR023152471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered175F00000XOther Service ProvidersNaturopath
Not Answered2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR290783Medicaid
OR290783Medicaid