Healthcare Provider Details

I. General information

NPI: 1528296076
Provider Name (Legal Business Name): KRISTOPHER GRAY HOOTEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1393 GEORGE DIETER DR STE A
EL PASO TX
79936-7410
US

IV. Provider business mailing address

7500 VISCOUNT BLVD
EL PASO TX
79925-5638
US

V. Phone/Fax

Practice location:
  • Phone: 915-231-2381
  • Fax: 915-231-2382
Mailing address:
  • Phone: 915-200-2694
  • Fax: 915-521-2278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberD0096420
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME109862
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: