Healthcare Provider Details

I. General information

NPI: 1336256429
Provider Name (Legal Business Name): TIMOTHY ALBERT HOOVER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040A JACKSON AVE
JOINT BASE LEWIS MCCHORD WA
98431-0001
US

IV. Provider business mailing address

TF 2-9 IN BN UNIT 15101 APO AP 96224
APO AP SOUTH KOREA
96224-5101
KR

V. Phone/Fax

Practice location:
  • Phone: 253-967-9590
  • Fax:
Mailing address:
  • Phone: 01022033331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: