Healthcare Provider Details

I. General information

NPI: 1922042027
Provider Name (Legal Business Name): JAMES HOVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 COUNTY RD 120
SAINT CLOUD MN
56303-4665
US

IV. Provider business mailing address

251 COUNTY RD 120
SAINT CLOUD MN
56303-4665
US

V. Phone/Fax

Practice location:
  • Phone: 320-202-8949
  • Fax: 320-202-0756
Mailing address:
  • Phone: 320-202-8949
  • Fax: 320-202-0756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21111
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: