Provider Demographics
NPI:1679325377
Name:HOOKER, JOHN WILBREN IV (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILBREN
Last Name:HOOKER
Suffix:IV
Gender:M
Credentials:DO
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Mailing Address - Street 1:116 STONE RIDGE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-1563
Mailing Address - Country:US
Mailing Address - Phone:314-637-0900
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS RD STE 3019B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8267
Practice Address - Country:US
Practice Address - Phone:314-509-5305
Practice Address - Fax:314-251-4454
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MO202402236390200000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program