MEDICARE: JEDEDIAH MUIR HOOPER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	A93285	CA
2	2084P0804X	Child & Adolescent Psychiatry Physician	A93285	CA

General Provider Information

NPI Number	:	1144300690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEDEDIAH MUIR HOOPER M.D.

Provider Business Mailing Address
First Line	:	2415 UNIVERSITY AVE
Second Line	:	EAST PALO ALTO COMMUNITY COUNSELLING - 3RD FLOOR
City	:	EAST PALO ALTO
State	:	CA
Zip	:	94303-1164
Country	:	US
Telephone Number	:	650-773-1471
Fax Number	:	650-489-1320

Provider Business Practice Location Address
First Line	:	2415 UNIVERSITY AVE
Second Line	:	EAST PALO ALTO COMMUNITY COUNSELLING - 3RD FLOOR
City	:	EAST PALO ALTO
State	:	CA
Zip	:	94303-1164
Country	:	US
Telephone Number	:	650-773-1471
Fax Number	:	650-489-1320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	01/12/2011

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