Provider Demographics
NPI:1336213420
Name:BOPF, KEITH THOMAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:THOMAS
Last Name:BOPF
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 1:1261 S ROUTE 9 STE 4
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2761
Mailing Address - Country:US
Mailing Address - Phone:609-465-5599
Mailing Address - Fax:609-465-8360
Practice Address - Street 1:1261 S ROUTE 9 STE 4
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2761
Practice Address - Country:US
Practice Address - Phone:609-465-5599
Practice Address - Fax:609-465-8360
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD2208213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6023908Medicaid
0000043675Medicare NSC
NJ6023908Medicaid
NJU34624Medicare UPIN