Provider Demographics
NPI:1750472304
Name:KOPP, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:KOPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 4TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2558
Mailing Address - Country:US
Mailing Address - Phone:541-963-9843
Mailing Address - Fax:541-963-8746
Practice Address - Street 1:1902 4TH ST STE 3
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2558
Practice Address - Country:US
Practice Address - Phone:541-963-9843
Practice Address - Fax:541-963-8746
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09796207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022801000OtherBCBSO
OR281394Medicaid
OR022801000OtherBCBSO
ORC94400Medicare UPIN
OR281394Medicaid