Provider Demographics
NPI:1831110360
Name:HOPSON, KEVIN R (DPM)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:HOPSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 PARRISH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1791
Mailing Address - Country:US
Mailing Address - Phone:585-394-1960
Mailing Address - Fax:585-393-9232
Practice Address - Street 1:229 PARRISH ST STE 100
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1791
Practice Address - Country:US
Practice Address - Phone:585-394-1960
Practice Address - Fax:585-393-9232
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005954213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD6255Medicare PIN
U95999Medicare UPIN