Provider Demographics
NPI:1689645129
Name:HOOPES, JAMES ORVEL (PAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ORVEL
Last Name:HOOPES
Suffix:
Gender:M
Credentials:PAC
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 15
Mailing Address - Street 2:
Mailing Address - City:NEOLA
Mailing Address - State:UT
Mailing Address - Zip Code:84053-0015
Mailing Address - Country:US
Mailing Address - Phone:435-353-4116
Mailing Address - Fax:
Practice Address - Street 1:210 W 300 N # 75-3
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-2336
Practice Address - Country:US
Practice Address - Phone:435-722-6130
Practice Address - Fax:435-725-2033
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPAC656363AM0700X
UT101650-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2402247Medicaid
NV3102247Medicaid
NV33816Medicare PIN
NV3102247Medicaid