Provider Demographics
NPI:1396811105
Name:HOOKERMAN, BRUCE J (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:J
Last Name:HOOKERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12105 BRIDGETON SQUARE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2616
Mailing Address - Country:US
Mailing Address - Phone:314-291-2588
Mailing Address - Fax:314-291-4104
Practice Address - Street 1:12105 BRIDGETON SQUARE DRIVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2616
Practice Address - Country:US
Practice Address - Phone:314-291-2588
Practice Address - Fax:314-291-4104
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO31696207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
100861OtherHEALTHLINK
72155018OtherRAILROAD MEDICARE PALMETT
CS4712OtherRAILROAD MEDICARE PALMETT
20867OtherBCBS OF MO
MO202820213Medicaid
96698OtherUNITED HEALTHCARE
20867OtherBCBS OF MO
A10833Medicare UPIN
100861OtherHEALTHLINK