Provider Demographics
NPI:1760075253
Name:HOPKINS DERMATOLOGY APMC
Entity Type:Organization
Organization Name:HOPKINS DERMATOLOGY APMC
Other - Org Name:HOPKINS DERMATOLOGY TEXAS PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-325-0600
Mailing Address - Street 1:2509 BROADMOOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3184
Mailing Address - Country:US
Mailing Address - Phone:682-271-0988
Mailing Address - Fax:
Practice Address - Street 1:321 W SOUTHLAKE BLVD STE 180
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6287
Practice Address - Country:US
Practice Address - Phone:682-271-0988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
86-1455811OtherINTERNAL REVENUE SERVICE