Provider Demographics
NPI:1255375812
Name:POPENEY, CHARLES A (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:A
Last Name:POPENEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 CORDES DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1353
Mailing Address - Country:US
Mailing Address - Phone:281-980-2525
Mailing Address - Fax:281-980-9344
Practice Address - Street 1:2655 CORDES DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1353
Practice Address - Country:US
Practice Address - Phone:281-980-2525
Practice Address - Fax:281-980-9344
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ22592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U97YOtherBLUECROSS/BLUESHIELD
TX136766605Medicaid
TX00U97YOtherBLUECROSS/BLUESHIELD