Provider Demographics
NPI:1477661213
Name:HOPPER, ROBERT BRUCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUCE
Last Name:HOPPER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BROADWAY ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-3343
Mailing Address - Country:US
Mailing Address - Phone:303-494-5226
Mailing Address - Fax:303-499-4176
Practice Address - Street 1:350 BROADWAY ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-3343
Practice Address - Country:US
Practice Address - Phone:303-494-5226
Practice Address - Fax:303-499-4176
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO673103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07100696Medicare ID - Type Unspecified
CO91386Medicare ID - Type Unspecified