Healthcare Provider Details

I. General information

NPI: 1194741249
Provider Name (Legal Business Name): GEOFFREY W HOOVER MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 N BRYANT AVE STE 1
EDMOND OK
73034-6349
US

IV. Provider business mailing address

122 N BRYANT AVE STE 1
EDMOND OK
73034-6349
US

V. Phone/Fax

Practice location:
  • Phone: 405-216-8960
  • Fax: 405-216-8965
Mailing address:
  • Phone: 405-216-8960
  • Fax: 405-216-8965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number21239
License Number StateOK

VIII. Authorized Official

Name: GEOFFREY HOOVER
Title or Position: OWNER
Credential: M.D.
Phone: 405-216-8960