Provider Demographics
NPI:1821034257
Name:KOPITA, JEFFREY M (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:KOPITA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 960
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-820-5630
Mailing Address - Fax:214-820-9818
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:SUITE 960
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-820-5630
Practice Address - Fax:214-820-9818
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ8018207RP1001X, 207RH0002X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1185258-04Medicaid
TX8BN465OtherBCBS
TX83301XOtherBCBS
TX118525801Medicaid
TX118525805Medicaid
TX1185258-04Medicaid
TX83301XOtherBCBS
TX290011755Medicare PIN
TX8L0533Medicare PIN
TX84923NMedicare PIN