Provider Demographics
NPI:1790732659
Name:POPEK, EDWINA JANE (DO)
Entity Type:Individual
Prefix:
First Name:EDWINA
Middle Name:JANE
Last Name:POPEK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 741169
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77274-1169
Mailing Address - Country:US
Mailing Address - Phone:832-824-1866
Mailing Address - Fax:832-825-1032
Practice Address - Street 1:6621 FANNIN STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2399
Practice Address - Country:US
Practice Address - Phone:832-824-1866
Practice Address - Fax:832-825-1032
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1519207ZP0102X, 207ZP0213X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129399501Medicaid
TX129399509Medicaid
TX8C8691Medicare PIN
TX82P928Medicare PIN
TX81P069Medicare PIN
TX129399509Medicaid