Provider Demographics
NPI:1588698831
Name:POPPEN, ROBIN SCOTT (MD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:SCOTT
Last Name:POPPEN
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 1:10965 S STATE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4270
Mailing Address - Country:US
Mailing Address - Phone:801-572-0311
Mailing Address - Fax:801-571-1369
Practice Address - Street 1:10965 S STATE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4270
Practice Address - Country:US
Practice Address - Phone:801-572-0311
Practice Address - Fax:801-571-1369
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT188759-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTA29007Medicare UPIN