Healthcare Provider Details

I. General information

NPI: 1356318455
Provider Name (Legal Business Name): JERRY L. HOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S CAPITAL OF TEXAS HWY BLDG 3 FIRST FLOOR
AUSTIN TX
78746-6446
US

IV. Provider business mailing address

12221 MOPAC EXPRESSWAY NORTH
AUSTIN TX
78758-2483
US

V. Phone/Fax

Practice location:
  • Phone: 512-334-2403
  • Fax: 512-334-2493
Mailing address:
  • Phone: 512-334-2403
  • Fax: 512-334-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG1919
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: