Provider Demographics
NPI:1457576191
Name:KOPECKY, CHRISTOPHER LEON (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LEON
Last Name:KOPECKY
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 1:7922 EWING HALSELL
Mailing Address - Street 2:STE. 240
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-614-3021
Mailing Address - Fax:210-616-0208
Practice Address - Street 1:7922 EWING HALSELL
Practice Address - Street 2:STE. 240
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-614-3021
Practice Address - Fax:210-616-0208
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5986207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1386054-13Medicaid
TX1386054-13Medicaid
TX87X361Medicare PIN