Provider Demographics
NPI:1437128410
Name:HOOVER, JAMES P (DPM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:HOOVER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4699
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-4699
Mailing Address - Country:US
Mailing Address - Phone:765-449-2732
Mailing Address - Fax:765-449-1196
Practice Address - Street 1:2020 UNION ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3432
Practice Address - Country:US
Practice Address - Phone:765-447-7644
Practice Address - Fax:765-448-9009
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000331A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000110540OtherANTHEM PROVIDER NUMBER
IN480022194Medicare PIN
IN1272900006Medicare NSC
IN193290DMedicare PIN
IN000000110540OtherANTHEM PROVIDER NUMBER