Provider Demographics
NPI:1649236613
Name:PERRY, HOOVER A (MD)
Entity Type:Individual
Prefix:
First Name:HOOVER
Middle Name:A
Last Name:PERRY
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:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:WHITLEY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42653
Mailing Address - Country:US
Mailing Address - Phone:606-376-5363
Mailing Address - Fax:606-376-9919
Practice Address - Street 1:10 NORTH HWY 27
Practice Address - Street 2:
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653
Practice Address - Country:US
Practice Address - Phone:606-376-5363
Practice Address - Fax:606-376-9919
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12494208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1649236613OtherCHAMPVA
KY1649236613OtherADVANTRA FREEDOM
KY1649236613OtherAETNA
KY1649236613OtherCIGNA
KY163084700OtherFEDERAL BLACK LUNG
KY1649236613Medicaid
KY1649236613OtherBLUE CROSS AND BLUE SHIELD
KY1649236613OtherCONSECO
KY1649236613OtherAETNA
D92448Medicare UPIN