Healthcare Provider Details

I. General information

NPI: 1255517371
Provider Name (Legal Business Name): RENE KOPPEL, M.D. - A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 RUE DE SANTE SUITE #303
LA PLACE LA
70068-5424
US

IV. Provider business mailing address

3640 HOUMA BLVD
METAIRIE LA
70006-4230
US

V. Phone/Fax

Practice location:
  • Phone: 985-651-4432
  • Fax: 985-651-4474
Mailing address:
  • Phone: 504-454-1885
  • Fax: 504-454-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number022658
License Number StateLA

VIII. Authorized Official

Name: DR. RENE KOPPEL
Title or Position: DERMATOLOGIST
Credential: M.D.
Phone: 504-454-1885