Provider Demographics
NPI:1134408164
Name:FAMILY PODIATRY
Entity type:Organization
Organization Name:FAMILY PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-376-5112
Mailing Address - Street 1:500 NW 43D ST.
Mailing Address - Street 2:2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6126
Mailing Address - Country:US
Mailing Address - Phone:352-376-5112
Mailing Address - Fax:352-376-0320
Practice Address - Street 1:500 NW 43RD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6126
Practice Address - Country:US
Practice Address - Phone:352-376-5112
Practice Address - Fax:352-376-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6589760001Medicare NSC
FLFJ491AMedicare PIN