Healthcare Provider Details

I. General information

NPI: 1487717716
Provider Name (Legal Business Name): ANDREW J POPLAWSKI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3908 10TH ST SE
PUYALLUP WA
98374-2188
US

IV. Provider business mailing address

1600 WALLACE BLVD
AMARILLO TX
79106-1799
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-5951
  • Fax: 253-845-7073
Mailing address:
  • Phone: 806-358-0285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA15223
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: