Provider Demographics
NPI:1780790931
Name:LAWRENCE B HOOPER MD INC
Entity type:Organization
Organization Name:LAWRENCE B HOOPER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-245-4048
Mailing Address - Street 1:500 E REMINGTON DR STE 20
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2612
Mailing Address - Country:US
Mailing Address - Phone:408-245-4048
Mailing Address - Fax:408-245-6131
Practice Address - Street 1:500 E REMINGTON DR STE 20
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2612
Practice Address - Country:US
Practice Address - Phone:408-245-4048
Practice Address - Fax:408-245-6131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05979ZMedicare PIN