Healthcare Provider Details

I. General information

NPI: 1891888608
Provider Name (Legal Business Name): JEFFREY A. SCHOPP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N. 1ST STREET
SPRINGFIELD IL
62702
US

IV. Provider business mailing address

1001 E JOHNSON ST
HOLYOKE CO
80734-1854
US

V. Phone/Fax

Practice location:
  • Phone: 217-528-7541
  • Fax:
Mailing address:
  • Phone: 970-854-2241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR.0057869
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036-109266
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: