Provider Demographics
NPI:1306044417
Name:HOPEN AND WOLFE MD PA
Entity Type:Organization
Organization Name:HOPEN AND WOLFE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-989-2800
Mailing Address - Street 1:3419 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5420
Mailing Address - Country:US
Mailing Address - Phone:954-989-2800
Mailing Address - Fax:305-675-2788
Practice Address - Street 1:3419 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5420
Practice Address - Country:US
Practice Address - Phone:954-989-2800
Practice Address - Fax:305-675-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39576174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99087OtherBLUE CROSS BLUE SHIELD
99087Medicare PIN