Healthcare Provider Details

I. General information

NPI: 1093979163
Provider Name (Legal Business Name): POPP COSMETIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11919 GRANT ST SUITE 100
OMAHA NE
68164-3475
US

IV. Provider business mailing address

11919 GRANT ST SUITE 100
OMAHA NE
68164-3475
US

V. Phone/Fax

Practice location:
  • Phone: 402-391-4558
  • Fax: 402-391-7401
Mailing address:
  • Phone: 402-391-4558
  • Fax: 402-391-7401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number15046
License Number StateNE

VIII. Authorized Official

Name: DR. JEFFREY COLLINS POPP
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 402-391-4558