Provider Demographics
NPI:1174788756
Name:HOPPER, REBECCA DAWN (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DAWN
Last Name:HOPPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1252
Mailing Address - Country:US
Mailing Address - Phone:812-492-8310
Mailing Address - Fax:812-421-7497
Practice Address - Street 1:316 CHANDLER AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1147
Practice Address - Country:US
Practice Address - Phone:812-436-4501
Practice Address - Fax:812-436-4510
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1697208000000X
IN010844622A208000000X, 207R00000X
KY44606208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300043574Medicaid
KY7100188910Medicaid