Basic Information
Provider Information
NPI: 1619315850
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOOTEN
FirstName: RORAK
MiddleName: E
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1501 N CAMPBELL AVE
Address2: RM 6408
City: TUCSON
State: AZ
PostalCode: 857240001
CountryCode: US
TelephoneNumber: 5206262761
FaxNumber: 5206266020
Practice Location
Address1: 1501 N CAMPBELL AVE
Address2: RM 6408
City: TUCSON
State: AZ
PostalCode: 857240001
CountryCode: US
TelephoneNumber: 5206262761
FaxNumber: 5206266020
Other Information
ProviderEnumerationDate: 06/10/2013
LastUpdateDate: 06/10/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XR73893AZY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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