MEDICARE: EDMOND A HOOKER II 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	207P00000X	Emergency Medicine Physician	35.074240	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790789220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMOND A HOOKER II MD

Provider Business Mailing Address
First Line	:	PO BOX 636256
Second Line	:	CENTRAL CREDENTIALING
City	:	CINCINNATI
State	:	OH
Zip	:	45263-6256
Country	:	US
Telephone Number	:	513-585-5505
Fax Number	:	513-585-5511

Provider Business Practice Location Address
First Line	:	4440 RED BANK RD
Second Line	:	SUITE 110
City	:	CINCINNATI
State	:	OH
Zip	:	45227-2176
Country	:	US
Telephone Number	:	513-564-1366
Fax Number	:	513-564-1367

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	06/12/2017

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