Provider Demographics
NPI:1871584284
Name:HOPEN, BRUCE J (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:J
Last Name:HOPEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3534 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46809-1361
Mailing Address - Country:US
Mailing Address - Phone:260-747-6171
Mailing Address - Fax:260-478-5125
Practice Address - Street 1:3534 BROOKLYN AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46809-1361
Practice Address - Country:US
Practice Address - Phone:260-478-5130
Practice Address - Fax:260-478-5133
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2013-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01029474A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1412OtherPHYSICIANS HEALTH PLAN
IN080121944OtherRAILROAD MEDICARE
000000091883OtherBLUE CROSS BLUE SHIELD
000000000826OtherMPLAN
IN100318040Medicaid
IN925510QMedicare PIN
000000091883OtherBLUE CROSS BLUE SHIELD
IN925500BMedicare PIN
IN080121944OtherRAILROAD MEDICARE