Provider Demographics
NPI:1942279211
Name:POPE, CHARLES J (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:J
Last Name:POPE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:14396 CORRINE CT
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8250
Mailing Address - Country:US
Mailing Address - Phone:720-389-8471
Mailing Address - Fax:
Practice Address - Street 1:14396 CORRINE CT
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-8250
Practice Address - Country:US
Practice Address - Phone:720-389-8471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO194585367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered