=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871758805
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R. RANDY HOPKINS M.D. P.A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2008
-----------------------------------------------------
Last Update Date | 10/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1607 LINCOLN WAY SUITE 200
-----------------------------------------------------
City | COEUR D'ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-667-5483
-----------------------------------------------------
Fax | 208-667-7062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1607 LINCOLN WAY SUITE 200
-----------------------------------------------------
City | COEUR D'ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-667-5483
-----------------------------------------------------
Fax | 208-667-7062
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | R. RANDY HOPKINS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 208-667-5483
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | M7187
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | M7187
-----------------------------------------------------
License Number State |
-----------------------------------------------------