Provider Demographics
NPI:1780797712
Name:HOPKIN, JEFFREY GARDNER (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:GARDNER
Last Name:HOPKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 W 1ST S
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1810
Mailing Address - Country:US
Mailing Address - Phone:208-356-8883
Mailing Address - Fax:208-656-0292
Practice Address - Street 1:32 W 1ST S
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1810
Practice Address - Country:US
Practice Address - Phone:208-356-8883
Practice Address - Fax:208-656-0292
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-6910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003732000Medicaid
IDD37043Medicare UPIN
ID1375264Medicare ID - Type Unspecified