Provider Demographics
NPI:1942231220
Name:KOPPEL, LOWELL B (MD)
Entity Type:Individual
Prefix:
First Name:LOWELL
Middle Name:B
Last Name:KOPPEL
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 1:751 HEBRON PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5002
Mailing Address - Country:US
Mailing Address - Phone:972-459-2386
Mailing Address - Fax:972-459-2392
Practice Address - Street 1:751 HEBRON PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5002
Practice Address - Country:US
Practice Address - Phone:972-459-2386
Practice Address - Fax:972-459-2392
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155714204Medicaid
TX155714203Medicaid
TX155714203Medicaid
TX155714204Medicaid
TX8D5564Medicare ID - Type Unspecified