Healthcare Provider Details

I. General information

NPI: 1790732659
Provider Name (Legal Business Name): EDWINA JANE POPEK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN STREET
HOUSTON TX
77030-2399
US

IV. Provider business mailing address

PO BOX 741169
HOUSTON TX
77274-1169
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-1866
  • Fax: 832-825-1032
Mailing address:
  • Phone: 832-824-1866
  • Fax: 832-825-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberG1519
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License NumberG1519
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: