Healthcare Provider Details

I. General information

NPI: 1174577712
Provider Name (Legal Business Name): BRUCE DONALD HOPPER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5843 RISING SUN AVE
PHILADELPHIA PA
19120-1144
US

IV. Provider business mailing address

PO BOX 746723
ATLANTA GA
30374-6723
US

V. Phone/Fax

Practice location:
  • Phone: 215-437-0128
  • Fax: 215-857-0419
Mailing address:
  • Phone: 312-733-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD421377
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberMD421377
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: