Provider Demographics
NPI:1851316590
Name:HOPKINS, MARY JANINE O (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARY JANINE
Middle Name:O
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2509 BROADMOOR BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2987
Mailing Address - Country:US
Mailing Address - Phone:318-325-0600
Mailing Address - Fax:318-325-0890
Practice Address - Street 1:2509 BROADMOOR BLVD
Practice Address - Street 2:STE A
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2987
Practice Address - Country:US
Practice Address - Phone:318-325-0600
Practice Address - Fax:318-325-0890
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2021-05-27
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Provider Licenses
StateLicense IDTaxonomies
LA021601207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1660752Medicaid
G08607Medicare UPIN
LA1660752Medicaid