Provider Demographics
NPI:1992792857
Name:HOOVER, JUDITH LEE BOTTCHER (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:LEE BOTTCHER
Last Name:HOOVER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1592 HUNTSMAN DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-5236
Mailing Address - Country:US
Mailing Address - Phone:803-215-8999
Mailing Address - Fax:
Practice Address - Street 1:202 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-4939
Practice Address - Country:US
Practice Address - Phone:800-967-2289
Practice Address - Fax:855-462-9736
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17179207V00000X
GA93977207V00000X
WAIMLC.MD.61652289207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC171799Medicaid
SC171799Medicaid
SCF898947578Medicare ID - Type UnspecifiedMEDICARE