Healthcare Provider Details

I. General information

NPI: 1467012468
Provider Name (Legal Business Name): RICHARD L POPPE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 28TH ST
CENTRAL CITY NE
68826-2707
US

IV. Provider business mailing address

PO BOX 417
CENTRAL CITY NE
68826-0417
US

V. Phone/Fax

Practice location:
  • Phone: 308-946-3015
  • Fax:
Mailing address:
  • Phone: 308-946-3015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTEP8621
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33407
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: