Provider Demographics
NPI:1669512950
Name:CENTER FOR EXCELLENCE IN DERMATOLOGY, PLLC
Entity type:Organization
Organization Name:CENTER FOR EXCELLENCE IN DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-735-1100
Mailing Address - Street 1:8901 W GAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7190
Mailing Address - Country:US
Mailing Address - Phone:509-735-1100
Mailing Address - Fax:509-735-1180
Practice Address - Street 1:8901 W GAGE BLVD
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7190
Practice Address - Country:US
Practice Address - Phone:509-735-1100
Practice Address - Fax:509-735-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024575174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty