Provider Demographics
NPI:1083119804
Name:HOOPER, PERRY (MD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:
Last Name:HOOPER
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 1:9728 JUPITER PASS
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9390
Mailing Address - Country:US
Mailing Address - Phone:270-210-0911
Mailing Address - Fax:
Practice Address - Street 1:725 LAKEFRONT CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5893
Practice Address - Country:US
Practice Address - Phone:317-926-3739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-25
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN01089747A207N00000X
MA291441207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program