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General NPI Number Information
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NPI Number | 1972897734
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Entity Type | Organization
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Legal Business Name | PAUL M POPPER MD PA
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 21229 OLEAN BLVD UNIT D
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6719
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Country | US
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Telephone | 941-625-6223
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Fax | 941-627-2680
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Provider Business Mailing Address
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Address Line | 21229 OLEAN BLVD UNIT D
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6719
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Country | US
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Telephone | 941-625-6223
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Fax | 941-627-2680
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Authorized Official
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Title or Position | OWNER
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Name | PAUL M POPPER
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Credential | MD
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Telephone | 941-625-6223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME46549
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License Number State | FL
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