Provider Demographics
NPI:1992794846
Name:HOOPES, JR., PHILLIP CARL (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:CARL
Last Name:HOOPES, JR.
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 1:11820 S STATE ST
Mailing Address - Street 2:200
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7160
Mailing Address - Country:US
Mailing Address - Phone:801-568-0200
Mailing Address - Fax:801-563-0200
Practice Address - Street 1:11820 S. STATE ST
Practice Address - Street 2:STE. 200
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7160
Practice Address - Country:US
Practice Address - Phone:801-568-0200
Practice Address - Fax:801-563-0200
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT57266371205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH95031Medicare UPIN
UT005576310Medicare PIN