Provider Demographics
NPI:1619990678
Name:POPE, ISAAC S (MD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:S
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 1:230 WASHINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-9325
Mailing Address - Country:US
Mailing Address - Phone:360-736-9147
Mailing Address - Fax:360-736-9181
Practice Address - Street 1:230 WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9325
Practice Address - Country:US
Practice Address - Phone:360-736-9147
Practice Address - Fax:360-736-9181
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014729208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1488501Medicaid
WAAP8578140OtherDEA
WAA08272Medicare UPIN
WAAP8578140OtherDEA