Provider Demographics
NPI:1417924051
Name:POPP, JEFFREY COLLINS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:COLLINS
Last Name:POPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11919 GRANT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3475
Mailing Address - Country:US
Mailing Address - Phone:402-391-4558
Mailing Address - Fax:402-391-7401
Practice Address - Street 1:11919 GRANT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3475
Practice Address - Country:US
Practice Address - Phone:402-391-4558
Practice Address - Fax:402-391-7401
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE150462086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
497OtherMIDLANDS CHOICE
NE03330OtherBLUE CROSS BLUE SHIELD
NE47069713300Medicaid
B67895Medicare UPIN
NE47069713300Medicaid