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Individual

DR. IVERSON B HOPSON III

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1415 JEFF DAVIS AVE, SELMA, AL 36703-3833
(334) 874-4311
Mailing address
1415 JEFF DAVIS AVE, SELMA, AL 36703-3833
(334) 874-4311

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3989
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
008605170
AL
01
510-90415
BLUECROSS/BLUESHIELD
AL
Enumeration date
03/23/2008
Last updated
03/23/2008
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