Provider Demographics
NPI:1649760067
Name:HOOPER, WALTER J III (PA-C)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:J
Last Name:HOOPER
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PARIS IRONS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-2838
Mailing Address - Country:US
Mailing Address - Phone:401-484-0424
Mailing Address - Fax:
Practice Address - Street 1:712 PUTNAM PIKE UNIT 2
Practice Address - Street 2:
Practice Address - City:CHEPACHET
Practice Address - State:RI
Practice Address - Zip Code:02814-1404
Practice Address - Country:US
Practice Address - Phone:401-484-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA01060363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty