Provider Demographics
NPI:1063422566
Name:POPE, GEORGE HAYNES (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:HAYNES
Last Name:POPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4459
Mailing Address - Country:US
Mailing Address - Phone:407-857-6261
Mailing Address - Fax:407-857-6241
Practice Address - Street 1:2629 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4459
Practice Address - Country:US
Practice Address - Phone:407-857-6261
Practice Address - Fax:407-857-6241
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053077174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07135OtherBC/BC
FL30-0297065OtherTAX ID
FL2730805OtherCIGNA
FL4219467OtherAETNA PROVIDER NUMBER
FLC76558Medicare UPIN