Basic Information
| Provider Information | |||||||||
| NPI: | 1740219112 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOPPER | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1675 E MAIN ST | ||||||||
| Address2: | BOX 328 | ||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442405818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306773632 | ||||||||
| FaxNumber: | 3306778770 | ||||||||
| Practice Location | |||||||||
| Address1: | 1930 STATE ROUTE 59 | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442404112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306773632 | ||||||||
| FaxNumber: | 3306778770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 174400000X | MD040093E | PA | Y | Other Service Providers | Specialist |
No ID Information.