Provider Demographics
NPI:1679560239
Name:HOOPER, ROBERT LANE (AUD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LANE
Last Name:HOOPER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7181 COLLEGE PKWY
Mailing Address - Street 2:STE 14
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5669
Mailing Address - Country:US
Mailing Address - Phone:239-275-7655
Mailing Address - Fax:239-275-6889
Practice Address - Street 1:7181 COLLEGE PKWY
Practice Address - Street 2:STE 14
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5669
Practice Address - Country:US
Practice Address - Phone:239-275-7655
Practice Address - Fax:239-275-6889
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY248231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6695164003OtherCIGNA
S0580ZMedicare ID - Type Unspecified
6695164003OtherCIGNA