Provider Demographics
NPI:1407879240
Name:HOPSON, RAYMOND DUANE (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:DUANE
Last Name:HOPSON
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 1:2968 FM 3129 S
Mailing Address - Street 2:
Mailing Address - City:BLOOMBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75556-4090
Mailing Address - Country:US
Mailing Address - Phone:903-923-6112
Mailing Address - Fax:
Practice Address - Street 1:555 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4808
Practice Address - Country:US
Practice Address - Phone:530-251-8108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK45952084P0800X
CA1083442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD 40281Medicaid
C17092Medicare UPIN
AKMD 40281Medicaid