Provider Demographics
NPI:1528731346
Name:BOPPANA, HEMANTH KRISHNA (MD)
Entity type:Individual
Prefix:
First Name:HEMANTH KRISHNA
Middle Name:
Last Name:BOPPANA
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 1:555 W 8TH ST FL P184
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6552
Mailing Address - Country:US
Mailing Address - Phone:904-244-1658
Mailing Address - Fax:
Practice Address - Street 1:555 W 8TH ST FL P184
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6552
Practice Address - Country:US
Practice Address - Phone:904-244-1658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program