Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 11530 | MO |
NPI | 1053472100 |
---|---|
Provider Name | Dr. John Carter Hoppin |
First Address | Chesterfield, MO 63017 |
Second Address | St Charles, MO 63301-2541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11530 | STATE (01) | MO |