Provider Demographics
NPI:1285741298
Name:HOPEN, GARY R (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:R
Last Name:HOPEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 39209
Mailing Address - Street 2:
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339
Mailing Address - Country:US
Mailing Address - Phone:954-851-9966
Mailing Address - Fax:954-318-7360
Practice Address - Street 1:3419 JOHNSON ST.
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-989-2800
Practice Address - Fax:954-989-2873
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39576207W00000X
FLME0039576207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004604OtherAV MED
FL062035100Medicaid
FL180031909OtherRAILROAD MEDICARE
FL25043OtherEMPLOYERS MUTUAL
FL1026377OtherAETNA
FL94115OtherBC/BS OF FL
FL1675828OtherCIGNA
94115YMedicare PIN
FLD27771Medicare UPIN
FL062035100Medicaid