Provider Demographics
NPI:1063475630
Name:HOPP, PHILIP H (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:H
Last Name:HOPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1210
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-1210
Mailing Address - Country:US
Mailing Address - Phone:501-329-1800
Mailing Address - Fax:501-329-2507
Practice Address - Street 1:2710 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6141
Practice Address - Country:US
Practice Address - Phone:501-329-1800
Practice Address - Fax:501-329-2507
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3293208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
5M275Medicare ID - Type Unspecified
H66153Medicare UPIN