Provider Demographics
NPI:1588661920
Name:POPHAM, JERRY KIRK (MD)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:KIRK
Last Name:POPHAM
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1800 EMERSON ST
Mailing Address - Street 2:#200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1014
Mailing Address - Country:US
Mailing Address - Phone:303-468-8844
Mailing Address - Fax:303-468-8850
Practice Address - Street 1:1800 EMERSON ST
Practice Address - Street 2:#200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1014
Practice Address - Country:US
Practice Address - Phone:303-468-8844
Practice Address - Fax:303-468-8850
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2013-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CODR27698207W00000X
KS04-23793207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98806033Medicaid
CO38215Medicare UPIN
COC538808Medicare PIN
CO98806033Medicaid