Provider Demographics
NPI:1588682058
Name:POPE, JOHN BARTELS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BARTELS
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 1:9425 HEALTHPLEX DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-8148
Mailing Address - Country:US
Mailing Address - Phone:318-683-5171
Mailing Address - Fax:318-683-5182
Practice Address - Street 1:9425 HEALTHPLEX DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-8148
Practice Address - Country:US
Practice Address - Phone:318-683-5171
Practice Address - Fax:318-683-5182
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5N526CD73OtherMEDICARE GROUP ID
LA1918962Medicaid
LA5N526Medicare PIN
LA5N526CD73OtherMEDICARE GROUP ID