Provider Demographics
NPI:1659393767
Name:HOPPER, GAYLE ANN (MD)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:ANN
Last Name:HOPPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22232 EUCALYPTUS LN
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8970 WARNER AVE
Practice Address - Street 2:MED ONE FAMILY MEDICAL GROUP INC
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-848-7757
Practice Address - Fax:714-848-7760
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0094190Medicaid
C49074Medicare UPIN
WG83528AMedicare PIN