Provider Demographics
NPI:1992892590
Name:HOPFENSPERGER, KURT J (MD)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:J
Last Name:HOPFENSPERGER
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 1:2301 HOUSE AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3176
Mailing Address - Country:US
Mailing Address - Phone:307-432-0335
Mailing Address - Fax:307-432-0341
Practice Address - Street 1:2301 HOUSE AVE
Practice Address - Street 2:STE 203
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3176
Practice Address - Country:US
Practice Address - Phone:307-432-0335
Practice Address - Fax:307-432-0341
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6471A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYG19384Medicare UPIN
WY9649Medicare ID - Type UnspecifiedMEDICARE