Provider Demographics
NPI:1962493577
Name:HOOVER, RICK D (DO)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:D
Last Name:HOOVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3300 LADNIER RD
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5900
Mailing Address - Country:US
Mailing Address - Phone:228-497-2652
Mailing Address - Fax:228-497-6253
Practice Address - Street 1:3300 LADNIER RD
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-5900
Practice Address - Country:US
Practice Address - Phone:228-497-2652
Practice Address - Fax:228-497-6253
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118337Medicaid
640932244OtherCHAMPUS
640932244OtherCOMMERCIAL
640932244OtherCOMMERCIAL
MS080003417Medicare ID - Type Unspecified