Provider Demographics
NPI:1801835509
Name:HOPP, ROBERT BLAINE (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BLAINE
Last Name:HOPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 W GAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7148
Mailing Address - Country:US
Mailing Address - Phone:509-735-1100
Mailing Address - Fax:509-735-1180
Practice Address - Street 1:8901 W GAGE BLVD
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7148
Practice Address - Country:US
Practice Address - Phone:509-735-1100
Practice Address - Fax:509-735-1180
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA24575207N00000X, 207ND0900X, 207ND0101X, 207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA06626Medicare UPIN