Provider Demographics
NPI:1780614867
Name:HOOPER, ARCHIE DEAN IV (MD)
Entity type:Individual
Prefix:DR
First Name:ARCHIE
Middle Name:DEAN
Last Name:HOOPER
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:705 US HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-4113
Mailing Address - Country:US
Mailing Address - Phone:334-289-0225
Mailing Address - Fax:334-287-0245
Practice Address - Street 1:705 US HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-4113
Practice Address - Country:US
Practice Address - Phone:334-289-0225
Practice Address - Fax:334-287-0245
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.27084207Q00000X
MS19584207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL543989004Medicaid