Provider Demographics
NPI:1598192890
Name:JOHN S. KOPPMAN MD PL
Entity Type:Organization
Organization Name:JOHN S. KOPPMAN MD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOPPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-826-3469
Mailing Address - Street 1:201 HEALTH PARK BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5796
Mailing Address - Country:US
Mailing Address - Phone:904-826-3469
Mailing Address - Fax:
Practice Address - Street 1:201 HEALTH PARK BLVD
Practice Address - Street 2:STE 103
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5796
Practice Address - Country:US
Practice Address - Phone:904-826-3469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93820208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI38489Medicare UPIN