MEDICARE: MR. JOHN W POPP M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	9519	SC

General Provider Information

NPI Number	:	1770564544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN W POPP M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4376
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29240-4376
Country	:	US
Telephone Number	:	803-799-4800
Fax Number	:	803-256-0395

Provider Business Practice Location Address
First Line	:	2739 LAUREL ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2028
Country	:	US
Telephone Number	:	803-799-4800
Fax Number	:	803-256-0395

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/08/2007

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