MEDICARE: STEPHEN P. COPPA D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OS9049	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	82311	OTHER	FL	BCBS FL

General Provider Information

NPI Number	:	1376540500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN P. COPPA D.O.

Provider Business Mailing Address
First Line	:	PO BOX 25487
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34277-2487
Country	:	US
Telephone Number	:	941-371-3500
Fax Number	:	855-253-4836

Provider Business Practice Location Address
First Line	:	6110 53RD AVE E
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34203-9707
Country	:	US
Telephone Number	:	941-755-4242
Fax Number	:	941-755-1906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	10/07/2015

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Directions to “ STEPHEN P. COPPA D.O.” Practice Location

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