Provider Demographics
NPI:1053032839
Name:POPKES, GARY
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:POPKES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48011 271ST ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57032-8228
Mailing Address - Country:US
Mailing Address - Phone:605-370-4317
Mailing Address - Fax:
Practice Address - Street 1:48011 271ST ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:SD
Practice Address - Zip Code:57032-8228
Practice Address - Country:US
Practice Address - Phone:605-370-4317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor