Individual
MARK J POPOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3883 AIRWAY DR STE 100, SANTA ROSA, CA 95403-1672
(707) 521-4480
(707) 521-4460
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
(707) 521-4480
(707) 521-4460
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
G57995
CA
2085N0904X
Nuclear Radiology Physician
G57995
CA
2085R0202X
Diagnostic Radiology Physician
Primary
G57995
CA
2085U0001X
Diagnostic Ultrasound Physician
G57995
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G579950
—
CA
01
—
473423
AMERICAN BOARD OF RADIOLOGY
CA
01
—
G57995
STATE MEDICAL LICENSE
CA
Enumeration date
10/13/2006
Last updated
08/26/2019
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