Provider Demographics
NPI:1861673501
Name:HOVER, MARA L (DO)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:L
Last Name:HOVER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:17220 N BOSWELL BLVD
Mailing Address - Street 2:STE 200W
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-2000
Mailing Address - Country:US
Mailing Address - Phone:623-556-8860
Mailing Address - Fax:623-876-9559
Practice Address - Street 1:2204 S DOBSON RD
Practice Address - Street 2:STE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6457
Practice Address - Country:US
Practice Address - Phone:480-491-6235
Practice Address - Fax:480-491-6239
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2009-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ4552208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDO00618OtherLICENSE
AZ4552OtherLICENSE