Provider Demographics
NPI:1972897734
Name:PAUL M POPPER MD PA
Entity Type:Organization
Organization Name:PAUL M POPPER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:POPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-625-6223
Mailing Address - Street 1:21229 OLEAN BLVD
Mailing Address - Street 2:UNIT D
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6719
Mailing Address - Country:US
Mailing Address - Phone:941-625-6223
Mailing Address - Fax:941-627-2680
Practice Address - Street 1:21229 OLEAN BLVD
Practice Address - Street 2:UNIT D
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6719
Practice Address - Country:US
Practice Address - Phone:941-625-6223
Practice Address - Fax:941-627-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46549207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME46549OtherSTATE LICENSE NUMBER