Provider Demographics
NPI:1407810062
Name:POPE, TAMMY K (MD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:K
Last Name:POPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:651 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-5000
Mailing Address - Country:US
Mailing Address - Phone:870-942-1301
Mailing Address - Fax:870-942-1305
Practice Address - Street 1:651 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-5000
Practice Address - Country:US
Practice Address - Phone:870-942-1301
Practice Address - Fax:870-942-1305
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0356207L00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128522001Medicaid
AR908683OtherMEDICARE