Basic Information
| Provider Information | |||||||||
| NPI: | 1639155245 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOPPER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2726 HIGHWAY 35 N | ||||||||
| Address2: | |||||||||
| City: | ROCKPORT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 783825709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3617295357 | ||||||||
| FaxNumber: | 3617272036 | ||||||||
| Practice Location | |||||||||
| Address1: | 2726 HIGHWAY 35 N | ||||||||
| Address2: | |||||||||
| City: | ROCKPORT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 783825709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3617295357 | ||||||||
| FaxNumber: | 3617272036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 05/27/2015 | ||||||||
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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 | 2084P0800X | D4158 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 128324402 | 05 | TX | MEDICAID | 00H80L | 01 | TX | BCBS OF TX # | OTHER | 84-0851219 | 01 | TAX ID # | OTHER |