Provider Demographics
NPI:1093874992
Name:POPE, FREDERICK EAGLES (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:EAGLES
Last Name:POPE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2712 BAYCLIFF CT
Mailing Address - Street 2:UNIT 1
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1709
Mailing Address - Country:US
Mailing Address - Phone:702-401-5471
Mailing Address - Fax:702-233-8919
Practice Address - Street 1:2980 S RAINBOW BLVD
Practice Address - Street 2:SUITE 210 G
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6531
Practice Address - Country:US
Practice Address - Phone:702-401-5471
Practice Address - Fax:702-233-8919
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVNV 31462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVA36571Medicare UPIN
NVV494628Medicare ID - Type UnspecifiedMEDICARE