Healthcare Provider Details

I. General information

NPI: 1225154545
Provider Name (Legal Business Name): DOUGLAS W POPE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N. 3RD STREET SUITE 3010
PHOENIX AZ
85020-2412
US

IV. Provider business mailing address

DEPT 8511
LOS ANGELES CA
90084-8511
US

V. Phone/Fax

Practice location:
  • Phone: 602-861-1168
  • Fax: 602-861-1763
Mailing address:
  • Phone: 602-861-1168
  • Fax: 602-678-6723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP1932
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN075687
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: