Provider Demographics
NPI:1295732741
Name:KOPPEL, SCOTT (DPM)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:KOPPEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NW 43RD STREET
Mailing Address - Street 2:STE 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 STREET
Practice Address - Street 2:STE 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
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00693755OtherRAILROAD MEDICARE
FL390321400Medicaid
FL390321400Medicaid
FL65417YMedicare PIN
FL390321400Medicaid