Provider Demographics
NPI:1699742031
Name:HOPKINS, RONALD D (PA)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:HOPKINS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 KINGSLEY AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5180
Mailing Address - Country:US
Mailing Address - Phone:904-276-7997
Mailing Address - Fax:904-276-7559
Practice Address - Street 1:2140 KINGSLEY AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5180
Practice Address - Country:US
Practice Address - Phone:904-276-7997
Practice Address - Fax:904-276-7559
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1914363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290665100Medicaid
FLP00234977OtherRR MEDICARE
FLP00234977OtherRR MEDICARE
FLS80611Medicare UPIN
FLE2552XMedicare ID - Type UnspecifiedINDIVIDUAL