Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | MED-POD-LIC-67915 | MT |
Y | 222Z00000X | Podiatrist | MED-POD-LIC-67915 | MT |
N | 213E00000X | Podiatrist | P-239 | ID |
N | 222Z00000X | Podiatrist | P-239 | ID |
NPI | 1013250950 |
---|---|
Provider Name | Justin Paul Hooker |
First Address | Shelby, MT 59474-0990 |
Second Address | Shelby, MT 59474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2013 |
Last Update Date | 12/03/2021 |