Basic Information
| Provider Information | |||||||||
| NPI: | 1093957482 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOSTETTER KROPF | ||||||||
| FirstName: | JESSE | ||||||||
| MiddleName: | A | ||||||||
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| OtherLastName: | KROPF | ||||||||
| OtherFirstName: | JESSE | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 600 NE 92ND AVE | ||||||||
| Address2: | PO BOX 1600 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986643225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605142142 | ||||||||
| FaxNumber: | 3605146820 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 NE 92ND AVE | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986643225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605142142 | ||||||||
| FaxNumber: | 3605146820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2009 | ||||||||
| LastUpdateDate: | 11/28/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD444103 | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 60278155 | WA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.