Provider Demographics
NPI:1568698736
Name:KOPP, JASON MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:MICHAEL
Last Name:KOPP
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50302-0424
Mailing Address - Country:US
Mailing Address - Phone:515-875-9255
Mailing Address - Fax:515-875-9223
Practice Address - Street 1:1025 SE TALLGRASS LANE, STE 250
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-6816
Practice Address - Country:US
Practice Address - Phone:515-875-8300
Practice Address - Fax:515-875-8201
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2024-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IADO-04188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine