Provider Demographics
NPI:1306809074
Name:POPE, DOUGLAS R (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
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:PO BOX 5559
Mailing Address - Street 2:STE 205
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-0559
Mailing Address - Country:US
Mailing Address - Phone:402-467-4661
Mailing Address - Fax:402-467-5006
Practice Address - Street 1:770 N COTNER BLVD
Practice Address - Street 2:STE 205
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2310
Practice Address - Country:US
Practice Address - Phone:402-467-4661
Practice Address - Fax:402-467-5006
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14951174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE14951OtherSTATE LICENSE NUMBER
NE47054632400Medicaid
NE01328OtherBCBS PROVIDER ID
NE080075500OtherRAILROAD MC PROVIDER #
NE080075500OtherRAILROAD MC PROVIDER #
NEAP8103195OtherDEA NUMBER
NE47054632400Medicaid