Provider Demographics
NPI:1932155223
Name:HOOPER, HENRY ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:ALLEN
Last Name:HOOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1601 CUMMINS DR. SUITE D
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-6403
Mailing Address - Country:US
Mailing Address - Phone:209-491-7710
Mailing Address - Fax:209-526-6808
Practice Address - Street 1:1600 N ROSE AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3722
Practice Address - Country:US
Practice Address - Phone:805-988-2674
Practice Address - Fax:805-981-4443
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG30054207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G300540Medicaid
CAWG30054AMedicare PIN
CAWG30054CMedicare PIN
CAWG30054Medicare PIN
CA00G300540Medicaid