Provider Demographics
NPI:1114974326
Name:HOOFT, RAYMOND PAUL (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:PAUL
Last Name:HOOFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-514-4400
Mailing Address - Fax:208-514-4404
Practice Address - Street 1:3041 E COPPER POINT DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1740
Practice Address - Country:US
Practice Address - Phone:208-514-4400
Practice Address - Fax:208-514-4404
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM5477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM5477OtherIDAHO MEDICAL LICENSE
IDBH1469419OtherDEA NUMBER
IDB64008Medicare UPIN
ID1120588Medicare PIN