Provider Demographics
NPI:1215001532
Name:KOPF, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:KOPF
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 1:3212 JEFFERSON ST
Mailing Address - Street 2:# 196
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3436
Mailing Address - Country:US
Mailing Address - Phone:707-255-8825
Mailing Address - Fax:
Practice Address - Street 1:3260 BEARD RD
Practice Address - Street 2:SUITE 5
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3423
Practice Address - Country:US
Practice Address - Phone:707-927-5136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66297208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A662970Medicaid
G51075Medicare UPIN
00A662970Medicare ID - Type Unspecified