Healthcare Provider Details

I. General information

NPI: 1215078647
Provider Name (Legal Business Name): JASON EDWARD POPE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date: 10/08/2018
Reactivation Date: 10/17/2018

III. Provider practice location address

220 CONCOURSE BLVD
SANTA ROSA CA
95403-8210
US

IV. Provider business mailing address

220 CONCOURSE BLVD
SANTA ROSA CA
95403-8210
US

V. Phone/Fax

Practice location:
  • Phone: 844-527-7369
  • Fax:
Mailing address:
  • Phone: 844-527-7369
  • Fax: 844-847-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA114663
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA114663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: