Provider Demographics
NPI:1518998681
Name:HOPPERT, JONATHAN H (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:H
Last Name:HOPPERT
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 1:1508 DIVISION ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1582
Mailing Address - Country:US
Mailing Address - Phone:503-656-0836
Mailing Address - Fax:503-656-9464
Practice Address - Street 1:1508 DIVISION ST
Practice Address - Street 2:SUITE 105
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1582
Practice Address - Country:US
Practice Address - Phone:503-656-0836
Practice Address - Fax:503-656-9464
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10937174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD72992Medicare UPIN