Provider Demographics
NPI:1952550295
Name:HOOVER, CODY M (DPM)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:M
Last Name:HOOVER
Suffix:
Gender:M
Credentials:DPM
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:16515 MERIDIAN E STE 105B
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6253
Mailing Address - Country:US
Mailing Address - Phone:253-987-9111
Mailing Address - Fax:844-827-2764
Practice Address - Street 1:16515 MERIDIAN E STE 105B
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6253
Practice Address - Country:US
Practice Address - Phone:253-987-9111
Practice Address - Fax:844-827-2764
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPO60211118213E00000X, 213EP1101X, 213ER0200X, 213ES0103X
PASC006067213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2090174Medicaid