Healthcare Provider Details

I. General information

NPI: 1952550295
Provider Name (Legal Business Name): CODY M HOOVER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16515 MERIDIAN E STE 105B
PUYALLUP WA
98375-6253
US

IV. Provider business mailing address

16515 MERIDIAN E STE 105B
PUYALLUP WA
98375-6253
US

V. Phone/Fax

Practice location:
  • Phone: 253-987-9111
  • Fax: 844-827-2764
Mailing address:
  • Phone: 253-987-9111
  • Fax: 844-827-2764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO60211118
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO60211118
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberPO60211118
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006067
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO60211118
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: