Provider Demographics
NPI:1013969583
Name:COPPOLA, JOSEPH P (DO)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:P
Last Name:COPPOLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 TIDEWATER PRESERVE BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5706
Mailing Address - Country:US
Mailing Address - Phone:413-658-7138
Mailing Address - Fax:
Practice Address - Street 1:5108 TIDEWATER PRESERVE BLVD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5706
Practice Address - Country:US
Practice Address - Phone:413-658-7138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7713207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009068100Medicaid
FL43872XMedicare PIN
NCF87649Medicare UPIN
F87649Medicare UPIN