Provider Demographics
NPI:1336137975
Name:HOPKINS, SAMUEL M (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:M
Last Name:HOPKINS
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 915389
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32791-5389
Mailing Address - Country:US
Mailing Address - Phone:407-875-8784
Mailing Address - Fax:
Practice Address - Street 1:136 PARLIAMENT LOOP
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3531
Practice Address - Country:US
Practice Address - Phone:407-333-0160
Practice Address - Fax:407-333-0108
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00163996RAILROADMedicare PIN
FLD62038Medicare UPIN
FL28088SMedicare PIN