Healthcare Provider Details

I. General information

NPI: 1689645129
Provider Name (Legal Business Name): JAMES ORVEL HOOPES PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W 300 N # 75-3
ROOSEVELT UT
84066-2336
US

IV. Provider business mailing address

PO BOX 15
NEOLA UT
84053-0015
US

V. Phone/Fax

Practice location:
  • Phone: 435-722-6130
  • Fax: 435-725-2033
Mailing address:
  • Phone: 435-353-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPAC656
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number101650-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: