Provider Demographics
NPI:1750675716
Name:KOPP, ANTHONY DANIEL (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DANIEL
Last Name:KOPP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-358-9461
Mailing Address - Fax:515-358-9489
Practice Address - Street 1:12493 UNIVERSITY AVE STE 100
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8286
Practice Address - Country:US
Practice Address - Phone:515-358-9461
Practice Address - Fax:515-358-9489
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-04706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine