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Individual
DR. SANDY POPHAM
Active
Individual
DR. SANDY POPHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
35304
MN
207RN0300X
Nephrology Physician
Primary
35304
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04N96P0
BLUE CROSS BLUE SHIELD
MN
01
—
3100318
MEDICA
MN
05
—
32439700
—
WI
05
—
476323800
—
MN
Enumeration date
05/08/2006
Last updated
01/20/2021
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