Provider Demographics
NPI:1922081900
Name:KOPPES, GERALD MAX (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:MAX
Last Name:KOPPES
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 1:525 OAK CENTRE DR STE 270
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3917
Mailing Address - Country:US
Mailing Address - Phone:210-270-2992
Mailing Address - Fax:210-224-7898
Practice Address - Street 1:525 OAK CENTRE DR STE 270
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3917
Practice Address - Country:US
Practice Address - Phone:210-270-2992
Practice Address - Fax:210-224-7898
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3343207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1371692-14Medicaid
TXP01267088OtherRR MEDICARE
TX1371692-14Medicaid
TXB126129Medicare PIN
TX137169213Medicaid
307982YUBLMedicare PIN
TXP00948226OtherRAILROAD