MEDICARE: DR. MATTHEW M POPPE 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	207Q00000X	Family Medicine Physician	5161	AK
2	2085R0001X	Radiation Oncology Physician	25MA08194700	NJ
3	2085R0001X	Radiation Oncology Physician	7692036-1205	UT

General Provider Information

NPI Number	:	1902888126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW M POPPE M.D.

Provider Business Mailing Address
First Line	:	1950 CIRCLE OF HOPE DR RM 1570
Second Line	:	DEPT. RADIATION ONCOLOGY
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5500
Country	:	US
Telephone Number	:	801-581-8793
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 CIRCLE OF HOPE DR RM 1570
Second Line	:	DEPT. RADIATION ONCOLOGY
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5500
Country	:	US
Telephone Number	:	801-581-8793
Fax Number	:

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	11/12/2021

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