Healthcare Provider Details

I. General information

NPI: 1942234190
Provider Name (Legal Business Name): BLAINE HENRY HOPPE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6917
US

IV. Provider business mailing address

4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6917
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-2180
  • Fax: 337-470-2677
Mailing address:
  • Phone: 337-470-2180
  • Fax: 337-470-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number022280
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME80986
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: