Provider Demographics
NPI:1760592349
Name:HOPP, RUSSELL J (DO)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:J
Last Name:HOPP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 CALIFORNIA PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68178-0001
Mailing Address - Country:US
Mailing Address - Phone:402-280-5828
Mailing Address - Fax:402-280-1410
Practice Address - Street 1:2412 CUMING ST
Practice Address - Street 2:SUITE 103
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-1601
Practice Address - Country:US
Practice Address - Phone:402-955-8100
Practice Address - Fax:402-955-8101
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE030003123Medicare PIN
NE086160Medicare PIN
NEB18031Medicare UPIN