Provider Demographics
NPI:1558498832
Name:POPE, ERNEST LAVERN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:LAVERN
Last Name:POPE
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 1:3556 N DUKE AV
Mailing Address - Street 2:#175
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-7845
Mailing Address - Country:US
Mailing Address - Phone:559-348-9701
Mailing Address - Fax:559-348-8701
Practice Address - Street 1:3556 N DUKE AV
Practice Address - Street 2:#175
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-7845
Practice Address - Country:US
Practice Address - Phone:559-348-9701
Practice Address - Fax:559-348-8701
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30005208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C300050Medicaid
0020048498OtherRAILRD
CA00C300050Medicare ID - Type Unspecified