Healthcare Provider Details

I. General information

NPI: 1790767663
Provider Name (Legal Business Name): BRIAN R HOOD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 HOSPITAL DR
JUNEAU AK
99801-7808
US

IV. Provider business mailing address

3260 HOSPITAL DR
JUNEAU AK
99801-7808
US

V. Phone/Fax

Practice location:
  • Phone: 907-796-8427
  • Fax:
Mailing address:
  • Phone: 907-796-8427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001297
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number246
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number803
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: