Provider Demographics
NPI:1942231014
Name:POPOWICH, YALE SANDS (MD)
Entity Type:Individual
Prefix:DR
First Name:YALE
Middle Name:SANDS
Last Name:POPOWICH
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 1:1200 NW NAITO PARKWAY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209
Mailing Address - Country:US
Mailing Address - Phone:503-292-9200
Mailing Address - Fax:503-292-9205
Practice Address - Street 1:1200 NW NAITO PARKWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209
Practice Address - Country:US
Practice Address - Phone:503-292-9200
Practice Address - Fax:503-292-9205
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26661208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORI59927Medicare UPIN