MEDICARE: RICHARD G HOOVER MD

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	207ZI0100X	Immunopathology Physician	R9589	MO
2	207ZP0007X	Molecular Genetic Pathology (Pathology) Physician	L9589	MO

General Provider Information

NPI Number	:	1437172616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD G HOOVER MD

Provider Business Mailing Address
First Line	:	3691 RUTGER AVE
Second Line	:	PROVIDER ENROLLMENT
City	:	ST LOUIS
State	:	MO
Zip	:	63110
Country	:	US
Telephone Number	:	314-977-4440
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 S GRAND
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63110
Country	:	US
Telephone Number	:	314-577-8693
Fax Number	:	314-268-5478

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	01/09/2008

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