Provider Demographics
NPI:1144300690
Name:HOOPER, JEDEDIAH MUIR (MD)
Entity type:Individual
Prefix:
First Name:JEDEDIAH
Middle Name:MUIR
Last Name:HOOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MUIR
Other - Middle Name:J
Other - Last Name:HOOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2415 UNIVERSITY AVE
Mailing Address - Street 2:EAST PALO ALTO COMMUNITY COUNSELLING - 3RD FLOOR
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-1164
Mailing Address - Country:US
Mailing Address - Phone:650-773-1471
Mailing Address - Fax:650-489-1320
Practice Address - Street 1:2415 UNIVERSITY AVE
Practice Address - Street 2:EAST PALO ALTO COMMUNITY COUNSELLING - 3RD FLOOR
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-1164
Practice Address - Country:US
Practice Address - Phone:650-773-1471
Practice Address - Fax:650-489-1320
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA932852084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry