Provider Demographics
NPI:1578778718
Name:HOPPER, DIXIE
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:
Last Name:HOPPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-6730
Mailing Address - Country:US
Mailing Address - Phone:918-687-5057
Mailing Address - Fax:
Practice Address - Street 1:1509 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-6730
Practice Address - Country:US
Practice Address - Phone:918-687-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle