Provider Demographics
NPI:1689617169
Name:KOPECKY, ALFRED A
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:A
Last Name:KOPECKY
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ALFRED
Other - Middle Name:A
Other - Last Name:KOPECKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2501 N NAVARRO ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3912
Mailing Address - Country:US
Mailing Address - Phone:361-573-6351
Mailing Address - Fax:361-575-6455
Practice Address - Street 1:2501 N NAVARRO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3912
Practice Address - Country:US
Practice Address - Phone:361-573-6351
Practice Address - Fax:361-575-6455
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0199208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089856103Medicaid
TX8AJ287OtherBLUE CROSS/BLUE SHIELD
TX4350502OtherUNITED HEALTHCARE
TX4350502OtherAETNA
TX4350502OtherAETNA
TX089856103Medicaid
TX4350502OtherUNITED HEALTHCARE