Provider Demographics
NPI:1154307742
Name:HOOPER, PHILIP L (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:L
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 1:55 WEST TIETAN
Mailing Address - Street 2:WALLA WALLA CLINIC
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362
Mailing Address - Country:US
Mailing Address - Phone:509-525-3720
Mailing Address - Fax:509-522-1593
Practice Address - Street 1:55 WEST TIETAN
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362
Practice Address - Country:US
Practice Address - Phone:509-525-3720
Practice Address - Fax:509-522-1593
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25226207R00000X
WATD60506751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01252268Medicaid
COC483568Medicare PIN