Healthcare Provider Details

I. General information

NPI: 1851316590
Provider Name (Legal Business Name): MARY JANINE O HOPKINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 BROADMOOR BLVD STE A
MONROE LA
71201-2987
US

IV. Provider business mailing address

2509 BROADMOOR BLVD STE A
MONROE LA
71201-2987
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-0600
  • Fax: 318-325-0890
Mailing address:
  • Phone: 318-325-0600
  • Fax: 318-325-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number021601
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: