Provider Demographics
NPI:1477559623
Name:KATOPODIS, JOHN NONDA (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:NONDA
Last Name:KATOPODIS
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 1:1300 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4646
Mailing Address - Country:US
Mailing Address - Phone:850-216-0100
Mailing Address - Fax:850-201-4834
Practice Address - Street 1:1300 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4646
Practice Address - Country:US
Practice Address - Phone:850-216-0100
Practice Address - Fax:850-201-4834
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51240207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00000OtherBLUE CROSS/BLUE SHIELD
FL0000OtherBEECH STREET/CAPP CARE
FL0000OtherFOCUS HC
GA000659062AMedicaid
AL009979020Medicaid
FL0000OtherSOUSTH CARE NETWORK
FL0000Medicaid
FL01106OtherUNIVERSAL HEALTH CARE
FL04619OtherBLUE CROSS BLUE SHIELD
FL0000OtherUNITED HEALTH CARE
FL00000OtherHUMANA/CHOICE CARE
D51068Medicare UPIN
GA000659062AMedicaid