Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 24575 | WA |
N | 207ND0101X | MOHS-Micrographic Surgeon | 24575 | WA |
N | 207ND0900X | Dermatopathologist | 24575 | WA |
NPI | 1801835509 |
---|---|
Provider Name | Mr. Robert Blaine Hopp |
First Address | Kennewick, WA 99336-7148 |
Second Address | Kennewick, WA 99336-7148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 21/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A06626 | (02) | WA |