Provider Demographics
NPI:1184606881
Name:HOPP, MARK L (CRNA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:HOPP
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:312 E MAIN ST
Mailing Address - Street 2:STE 2300, MARSHALLTOWN ANESTHESIOLOGISTS PLC
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-1888
Mailing Address - Country:US
Mailing Address - Phone:641-752-7149
Mailing Address - Fax:641-752-6320
Practice Address - Street 1:312 E MAIN ST
Practice Address - Street 2:STE 2300, MARSHALLTOWN ANESTHESIOLOGISTS PLC
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-1888
Practice Address - Country:US
Practice Address - Phone:641-752-7149
Practice Address - Fax:641-752-6320
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA41129367500000X
IA056492367500000X
IAD056492367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0168815Medicaid
IAIA0104OtherJOHN DEERE HEALTH
A006OtherTRIWEST
IA41908OtherWBCBS OF IA
IA0168815Medicaid