Provider Demographics
NPI:1720052988
Name:HOOPER, WILLIAM WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WAYNE
Last Name:HOOPER
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 1:320 SANTA FE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5138
Mailing Address - Country:US
Mailing Address - Phone:760-753-3424
Mailing Address - Fax:760-753-3425
Practice Address - Street 1:320 SANTA FE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5138
Practice Address - Country:US
Practice Address - Phone:760-753-3424
Practice Address - Fax:760-753-3425
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35446207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
290014892OtherRAILROAD MEDICARE
350050500OtherUS DEPT OF LABOR
CAZZZ02261ZMedicare ID - Type UnspecifiedNORTHERN CA
A46358Medicare UPIN
CAW19415Medicare ID - Type UnspecifiedSOUTHERN CA