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General NPI Number Information
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NPI Number | 1124681085
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Entity Type | Individual
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Provider Name | MARK HOPKINS MD
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Gender | Male
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Dates
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Enumeration Date | 04/17/2019
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone | 208-381-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 5972 N PORTSMOUTH AVE
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City | BOISE
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State | ID
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Zip | 83714-6144
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Country | US
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Telephone | 435-770-4928
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | MD210002052
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | 0101274679
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | D0093893
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | M-17235
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License Number State | ID
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