Provider Demographics
NPI:1619919503
Name:VOPAT, EDWARD P (PA-C)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:P
Last Name:VOPAT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 FAIRMONT BLVD
Mailing Address - Street 2:ATTEN CHRISTIE MSS
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7350
Mailing Address - Country:US
Mailing Address - Phone:303-467-4155
Mailing Address - Fax:303-467-4156
Practice Address - Street 1:2201 JACKSON BLVD
Practice Address - Street 2:100
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-4386
Practice Address - Country:US
Practice Address - Phone:605-755-2273
Practice Address - Fax:605-755-3902
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO393363A00000X
SD0874363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
970004830OtherMEDICARE RAILROAD
CO7393002Medicaid
970004830OtherMEDICARE RAILROAD
CO7393002Medicaid