Healthcare Provider Details

I. General information

NPI: 1295732741
Provider Name (Legal Business Name): SCOTT KOPPEL D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NW 43RD STREET STE 2
GAINESVILLE FL
32607-6126
US

IV. Provider business mailing address

500 NW 43RD STREET STE 2
GAINESVILLE FL
32607-6126
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-5112
  • Fax: 352-376-0320
Mailing address:
  • Phone: 352-376-5112
  • Fax: 352-376-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberP02501
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberP02501
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO 2501
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: