Provider Demographics
NPI:1447271291
Name:HOOVER, JEFFERY N (MD)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:N
Last Name:HOOVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4066 SUMMER AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-5225
Mailing Address - Country:US
Mailing Address - Phone:901-452-7391
Mailing Address - Fax:901-452-3439
Practice Address - Street 1:4066 SUMMER AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-5225
Practice Address - Country:US
Practice Address - Phone:901-452-7391
Practice Address - Fax:901-452-3439
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD14649207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN31996411Medicaid
B04863Medicare UPIN
TN31996411Medicaid