Provider Demographics
NPI:1679769913
Name:HOOPES, DEREK G (PA-C)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:G
Last Name:HOOPES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 ARROWHEAD DR STE 3
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-9307
Mailing Address - Country:US
Mailing Address - Phone:307-789-0096
Mailing Address - Fax:307-789-0860
Practice Address - Street 1:170 ARROWHEAD DR STE 3
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-9307
Practice Address - Country:US
Practice Address - Phone:307-789-0096
Practice Address - Fax:307-789-0860
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYTL429363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant