Provider Demographics
NPI:1609404219
Name:HOPKINS, DAULTON GARRETT (PA)
Entity Type:Individual
Prefix:
First Name:DAULTON
Middle Name:GARRETT
Last Name:HOPKINS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 W LAREDO LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-5506
Mailing Address - Country:US
Mailing Address - Phone:970-985-8698
Mailing Address - Fax:
Practice Address - Street 1:2760 S HIGHLAND AVE APT 232
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5429
Practice Address - Country:US
Practice Address - Phone:970-985-8698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ8229363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program