Basic Information
| Provider Information | |||||||||
| NPI: | 1619113214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOOPER | ||||||||
| FirstName: | RALPH | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 S HENDERSON ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761041017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173352583 | ||||||||
| FaxNumber: | 8173352597 | ||||||||
| Practice Location | |||||||||
| Address1: | 407 CANYON CREEK DR STE 108 | ||||||||
| Address2: | |||||||||
| City: | TEMPLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765023292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547783736 | ||||||||
| FaxNumber: | 2547712629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2009 | ||||||||
| LastUpdateDate: | 03/07/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 20008017910 | MO | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | 80492 | TX | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 20008017910 | 01 | MO | MISSOURI HIS | OTHER |