Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | G55188 | CA |
N | 207QA0401X | Family Doctor - Addiction Medicine | G55188 | CA |
Y | 208D00000X | General Practice Physician | G55188 | CA |
NPI | 1629097399 |
---|---|
Provider Name | Timothy D Hooper |
First Address | Twain Harte, CA 95383-9406 |
Second Address | Sonora, CA 95370-4856 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 06/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A52891 | (02) | CA |
ZZZ20686Z | (05) | CA |