Provider Demographics
NPI:1225026230
Name:HOOVER, LANCE M (MD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:M
Last Name:HOOVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4925 N O'CONNOR RD
Mailing Address - Street 2:#105
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062
Mailing Address - Country:US
Mailing Address - Phone:210-737-4406
Mailing Address - Fax:214-594-0203
Practice Address - Street 1:4925 N O'CONNOR
Practice Address - Street 2:#105
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062
Practice Address - Country:US
Practice Address - Phone:469-565-3502
Practice Address - Fax:214-594-0203
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK3753208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK050049927OtherRAILROAD MEDICARE
OK100148860BMedicaid
OK175450200OtherDEPT OF LABOR
TX8BG784OtherBCBS
TX198224101Medicaid
OK45490704002OtherBCBS OF OK
OK5809231OtherAETNA
OK731509526OtherEIN
OKF69507Medicare UPIN
OK731509526OtherEIN
TX198224101Medicaid