MEDICARE: GEORGE HAYNES POPE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME0053077	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07135	OTHER	FL	BC/BC
2	30-0297065	OTHER	FL	TAX ID
3	2730805	OTHER	FL	CIGNA
4	4219467	OTHER	FL	AETNA PROVIDER NUMBER

General Provider Information

NPI Number	:	1063422566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE HAYNES POPE M.D.

Provider Business Mailing Address
First Line	:	2629 EDGEWATER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4459
Country	:	US
Telephone Number	:	407-857-6261
Fax Number	:	407-857-6241

Provider Business Practice Location Address
First Line	:	2629 EDGEWATER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4459
Country	:	US
Telephone Number	:	407-857-6261
Fax Number	:	407-857-6241

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	08/12/2020

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