Provider Demographics
NPI:1679525844
Name:POPE, IVESTER ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:IVESTER
Middle Name:ALEXANDER
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 1:301 GOVERNORS DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5123
Mailing Address - Country:US
Mailing Address - Phone:256-551-4689
Mailing Address - Fax:256-551-4699
Practice Address - Street 1:2358 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5905
Practice Address - Country:US
Practice Address - Phone:256-593-3133
Practice Address - Fax:256-593-6673
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL14178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL89162OtherBCBS
ALC72719Medicare UPIN
000089162Medicare PIN