MEDICARE: LAWRENCE B HOOPER MD INC

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	207VG0400X	Gynecology Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1780790931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE B HOOPER MD INC

Provider Business Mailing Address
First Line	:	500 E REMINGTON DR STE 20
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-2612
Country	:	US
Telephone Number	:	408-245-4048
Fax Number	:	408-245-6131

Provider Business Practice Location Address
First Line	:	500 E REMINGTON DR STE 20
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-2612
Country	:	US
Telephone Number	:	408-245-4048
Fax Number	:	408-245-6131

Authorized Official
Title or Position	:	CREDENTIALING MGR
Name	:	MRS. KERRY A HOOPER
Credential	:
Telephone Number	:	408-245-4048

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	02/01/2012

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