Provider Demographics
NPI:1235761396
Name:POPMA, EASTON JAY (PA-C)
Entity Type:Individual
Prefix:
First Name:EASTON
Middle Name:JAY
Last Name:POPMA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:MN
Mailing Address - Zip Code:56232-2423
Mailing Address - Country:US
Mailing Address - Phone:320-226-5436
Mailing Address - Fax:
Practice Address - Street 1:30 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MN
Practice Address - Zip Code:56307-9379
Practice Address - Country:US
Practice Address - Phone:320-226-5436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13829363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant