Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | 25MA07775600 | NJ |
Y | 207QS0010X | Family Doctor - Sports Medicine | MD421377 | PA |
NPI | 1174577712 |
---|---|
Provider Name | Dr. Bruce Donald Hopper JR. |
First Address | Philadelphia, PA 19146-1542 |
Second Address | Philadelphia, PA 19146-1542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 27/07/2016 |