MEDICARE: MRS. MARY JANINE O HOPKINS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	021601	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851316590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY JANINE O HOPKINS MD

Provider Business Mailing Address
First Line	:	2509 BROADMOOR BLVD
Second Line	:	STE A
City	:	MONROE
State	:	LA
Zip	:	71201-2987
Country	:	US
Telephone Number	:	318-325-0600
Fax Number	:	318-325-0890

Provider Business Practice Location Address
First Line	:	2509 BROADMOOR BLVD
Second Line	:	STE A
City	:	MONROE
State	:	LA
Zip	:	71201-2987
Country	:	US
Telephone Number	:	318-325-0600
Fax Number	:	318-325-0890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	05/27/2021

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