Provider Demographics
NPI:1942234190
Name:HOPPE, BLAINE HENRY (MD)
Entity Type:Individual
Prefix:
First Name:BLAINE
Middle Name:HENRY
Last Name:HOPPE
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 1:4801 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6917
Mailing Address - Country:US
Mailing Address - Phone:337-470-2180
Mailing Address - Fax:337-470-2677
Practice Address - Street 1:4801 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6917
Practice Address - Country:US
Practice Address - Phone:337-470-2180
Practice Address - Fax:337-470-2677
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0222802085R0202X
FLME809862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1480070Medicaid
LA1480070Medicaid
LA4A163B219Medicare PIN
P00414583Medicare PIN
H23848Medicare UPIN
FL35830YMedicare PIN