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Individual

BRUCE J. HOPEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3534 BROOKLYN AVE, FORT WAYNE, IN 46809-1361
(260) 478-5130
(260) 478-5133
Mailing address
3534 BROOKLYN AVE, FORT WAYNE, IN 46809-1361
(260) 747-6171
(260) 478-5125

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01029474A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000000826
MPLAN
01
000000091883
BLUE CROSS BLUE SHIELD
01
080121944
RAILROAD MEDICARE
IN
05
100318040
IN
01
1412
PHYSICIANS HEALTH PLAN
Enumeration date
11/03/2005
Last updated
02/22/2013
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