=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477634608
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID W. POPP, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24165 IH10 WEST SUITE 114
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-687-1543
-----------------------------------------------------
Fax | 210-687-9543
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24165 IH-10 WEST SUITE 114
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-687-1543
-----------------------------------------------------
Fax | 210-687-9543
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID W POPP
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 210-687-1543
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | G8947
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------