Provider Demographics
NPI:1073613071
Name:POPE, MICHAEL P (MS, LAC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:POPE
Suffix:
Gender:M
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 WHITMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3705
Mailing Address - Country:US
Mailing Address - Phone:541-779-9393
Mailing Address - Fax:
Practice Address - Street 1:2612 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8344
Practice Address - Country:US
Practice Address - Phone:541-779-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00702171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist