Provider Demographics
NPI:1124045216
Name:POPPER, PAUL M (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:POPPER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:21229 OLEAN BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6719
Mailing Address - Country:US
Mailing Address - Phone:941-625-6223
Mailing Address - Fax:941-627-2680
Practice Address - Street 1:21229 OLEAN BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6719
Practice Address - Country:US
Practice Address - Phone:941-625-6223
Practice Address - Fax:941-627-2680
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME-0046549207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
5930135OtherAETNA
060012033OtherRAILROAD MEDICARE
592171328-002OtherTRICARE/CHAMPUS
FL046745600Medicaid
08148OtherBLUE SHIELD
1838539001OtherCIGNA
278926OtherWELLCARE
2101033OtherGHI
D61550Medicare UPIN
592171328-002OtherTRICARE/CHAMPUS