Healthcare Provider Details

I. General information

NPI: 1679804645
Provider Name (Legal Business Name): GERALD CLARK HOOVER JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 S ELM AVE
FRESNO CA
93706
US

IV. Provider business mailing address

2740 S ELM AVE
FRESNO CA
93706-5435
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-5200
  • Fax: 559-457-5290
Mailing address:
  • Phone: 559-457-5200
  • Fax: 559-457-5290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS016700
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A6186
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: