Individual
MR. JAMES J HOPPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5520 GODFREY RD STE B, GODFREY, IL 62035-2741
(618) 463-7800
Mailing address
5520 GODFREY RD STE B, GODFREY, IL 62035-2741
(618) 463-7800
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
085-000496
IL
363A00000X
Physician Assistant
Primary
085000496
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08220357
BCBS
IL
01
—
601151600
US DEPT OF LABOR
IL
01
—
900068033
TAX-ID#
IL
01
—
P00299510
RR MEDICARE#
IL
Enumeration date
05/03/2006
Last updated
04/06/2022
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