Provider Demographics
NPI:1457638884
Name:YALE S. POPOWICH, M.D., P.C.
Entity Type:Organization
Organization Name:YALE S. POPOWICH, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:YALE
Authorized Official - Middle Name:S
Authorized Official - Last Name:POPOWICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-546-1664
Mailing Address - Street 1:140 NW 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2601
Mailing Address - Country:US
Mailing Address - Phone:503-546-1664
Mailing Address - Fax:
Practice Address - Street 1:140 NW 14TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2601
Practice Address - Country:US
Practice Address - Phone:503-546-1664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD266661208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR135189Medicare UPIN