Provider Demographics
NPI:1689785032
Name:HOOVER, BARRY A (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:A
Last Name:HOOVER
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 1:8055 O ST
Mailing Address - Street 2:STE 300
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2580
Mailing Address - Country:US
Mailing Address - Phone:402-421-0896
Mailing Address - Fax:402-421-0945
Practice Address - Street 1:555 S 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2462
Practice Address - Country:US
Practice Address - Phone:402-219-7142
Practice Address - Fax:402-219-8961
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17952207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3914OtherMIDLANDS CHOICE
NE470780857 34Medicaid
IA0589564Medicaid
NE35188OtherBCBS
NE39-00277OtherUHC
SD7720580Medicaid
39-01298OtherUHC
SD7720580Medicaid
273755Medicare PIN
NE470780857 34Medicaid