1285741298 NPI number — GARY R HOPEN M.D.

Table of content: GARY R HOPEN M.D. (NPI 1285741298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285741298 NPI number — GARY R HOPEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOPEN
Provider First Name:
GARY
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285741298
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 39209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FT. LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-851-9966
Provider Business Mailing Address Fax Number:
954-318-7360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3419 JOHNSON ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-989-2800
Provider Business Practice Location Address Fax Number:
954-989-2873
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  39576 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: ME0039576 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004604 . This is a "AV MED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 062035100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180031909 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 25043 . This is a "EMPLOYERS MUTUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1026377 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 94115 . This is a "BC/BS OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1675828 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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