Provider Demographics
NPI:1548339047
Name:HOPKINS, R RANDY (MD)
Entity type:Individual
Prefix:DR
First Name:R
Middle Name:RANDY
Last Name:HOPKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:RANDY
Other - Last Name:HOPKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1607 LINCOLN WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2462
Mailing Address - Country:US
Mailing Address - Phone:208-667-5483
Mailing Address - Fax:208-667-7062
Practice Address - Street 1:1607 LINCOLN WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2462
Practice Address - Country:US
Practice Address - Phone:208-667-5483
Practice Address - Fax:208-667-7062
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7187207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID804078300Medicaid
A55008Medicare UPIN
PENDINGMedicare PIN