Provider Demographics
NPI:1356318455
Name:HOOD, JERRY L (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:L
Last Name:HOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 MOPAC EXPRESSWAY NORTH
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2483
Mailing Address - Country:US
Mailing Address - Phone:512-334-2403
Mailing Address - Fax:512-334-2493
Practice Address - Street 1:1250 S CAPITAL OF TEXAS HWY BLDG 3
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6446
Practice Address - Country:US
Practice Address - Phone:512-334-2403
Practice Address - Fax:512-334-2493
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1919207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128663504Medicaid
TX85E944Medicare PIN
TX128663504Medicaid
TX110057054Medicare PIN