Provider Demographics
NPI:1922025915
Name:HOFFMAN, GREGORY RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:RYAN
Last Name:HOFFMAN
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 1:701 GROVE RD
Mailing Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-5611
Mailing Address - Country:US
Mailing Address - Phone:864-455-6372
Mailing Address - Fax:
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:GMH ER ADMINISTRATION
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5611
Practice Address - Country:US
Practice Address - Phone:864-455-6372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22545207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC225456Medicaid
SC20028637OtherSELECT HEALTH
SC225456Medicaid