Provider Demographics
NPI:1093957482
Name:HOSTETTER KROPF, JESSE A
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:A
Last Name:HOSTETTER KROPF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:A
Other - Last Name:KROPF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:600 NE 92ND AVE
Mailing Address - Street 2:PO BOX 1600
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3225
Mailing Address - Country:US
Mailing Address - Phone:360-514-2142
Mailing Address - Fax:360-514-6820
Practice Address - Street 1:600 NE 92ND AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3225
Practice Address - Country:US
Practice Address - Phone:360-514-2142
Practice Address - Fax:360-514-6820
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD444103207P00000X
WA60278155207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine