Healthcare Provider Details

I. General information

NPI: 1760592349
Provider Name (Legal Business Name): RUSSELL J. HOPP D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 CUMING ST SUITE 103
OMAHA NE
68131-1601
US

IV. Provider business mailing address

2500 CALIFORNIA PLZ
OMAHA NE
68178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-8100
  • Fax: 402-955-8101
Mailing address:
  • Phone: 402-280-5828
  • Fax: 402-280-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number10
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: