Provider Demographics
NPI:1992437057
Name:ADVANCED GYNECOLOGY OF RENO POPPEN
Entity type:Organization
Organization Name:ADVANCED GYNECOLOGY OF RENO POPPEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:POPPEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:916-715-1244
Mailing Address - Street 1:PO BOX 11742
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89510-1742
Mailing Address - Country:US
Mailing Address - Phone:775-237-2833
Mailing Address - Fax:
Practice Address - Street 1:6630 S MCCARRAN BLVD STE A11
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6145
Practice Address - Country:US
Practice Address - Phone:775-237-2833
Practice Address - Fax:775-237-2823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty