Provider Demographics
NPI:1194807057
Name:HOPPE, LEIGH B (MD)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:B
Last Name:HOPPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 N LAWNWOOD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950
Mailing Address - Country:US
Mailing Address - Phone:772-489-6636
Mailing Address - Fax:772-489-5749
Practice Address - Street 1:1304 N LAWNWOOD CIRCLE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950
Practice Address - Country:US
Practice Address - Phone:772-489-6636
Practice Address - Fax:772-489-5749
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0079129207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258301100Medicaid
FL492692Medicare ID - Type Unspecified
E95707Medicare UPIN