Provider Demographics
NPI:1558467084
Name:HOPKIN, JEREMY RUDD (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:RUDD
Last Name:HOPKIN
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 1:2794 CANYON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4401
Mailing Address - Country:US
Mailing Address - Phone:801-699-6665
Mailing Address - Fax:
Practice Address - Street 1:1380 EAST MEDICAL CENTER DR
Practice Address - Street 2:DIXIE REGIONAL MEDICAL CENTER
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:801-225-6246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7261615-12052085B0100X, 2085D0003X
NHRT12342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000066655Medicare PIN