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General NPI Number Information
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NPI Number | 1770568875
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Entity Type | Individual
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Provider Name | CLINTON S POPPEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/12/2005
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Last Update Date | 07/29/2010
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Provider Practice Location Address
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Address Line | 12401 E SINTO AVE
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-1081
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Country | US
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Telephone | 509-922-2055
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Fax | 509-922-2307
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Provider Business Mailing Address
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Address Line | 3333 W HORIZON AVE
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City | SPOKANE
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State | WA
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Zip | 99208-8812
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Country | US
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Telephone | 509-448-7771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD00037066
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License Number State | WA
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