Provider Demographics
NPI:1225154545
Name:POPE, DOUGLAS W (FNP)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:W
Last Name:POPE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 8511
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-8511
Mailing Address - Country:US
Mailing Address - Phone:602-861-1168
Mailing Address - Fax:602-678-6723
Practice Address - Street 1:9250 N. 3RD STREET
Practice Address - Street 2:SUITE 3010
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2412
Practice Address - Country:US
Practice Address - Phone:602-861-1168
Practice Address - Fax:602-861-1763
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1932363L00000X
AZRN075687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ212690Medicaid
AZZ116507Medicare PIN