Provider Demographics
NPI:1477507978
Name:POPP, THERESA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:POPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:2120 S WAYSIDE DR
Practice Address - Street 2:STE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-3900
Practice Address - Country:US
Practice Address - Phone:713-803-1840
Practice Address - Fax:713-926-5852
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143364102Medicaid
TXGO8186Medicare UPIN
TX143364102Medicaid