Provider Demographics
NPI:1538251699
Name:HOFSTEDT, THEODORE R (MD)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:R
Last Name:HOFSTEDT
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 1:9250 N 3RD ST
Mailing Address - Street 2:SUITE 4030
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2412
Mailing Address - Country:US
Mailing Address - Phone:602-944-2271
Mailing Address - Fax:602-943-3420
Practice Address - Street 1:9250 N 3RD ST
Practice Address - Street 2:SUITE 4030
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2412
Practice Address - Country:US
Practice Address - Phone:602-944-2271
Practice Address - Fax:602-943-3420
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23010174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZWCHQHOtherMEDICARE PTAN
ZWCHQHOtherMEDICARE PTAN
AZF97710Medicare UPIN