Healthcare Provider Details

I. General information

NPI: 1083653539
Provider Name (Legal Business Name): JEFFREY DALLAS HOOPER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 SOUTH CEDAR ST #300/#200
TACOMA WA
98405
US

IV. Provider business mailing address

P.O. BOX 5299 MS: 737-3-PCON
TACOMA WA
98415-0299
US

V. Phone/Fax

Practice location:
  • Phone: 253-301-5280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOP00001972
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberOP00001972
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: