Healthcare Provider Details

I. General information

NPI: 1376616409
Provider Name (Legal Business Name): DOUGLAS A KOPPEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 HOUMA BLVD
METAIRIE LA
70006-4230
US

IV. Provider business mailing address

3640 HOUMA BLVD
METAIRIE LA
70006-4230
US

V. Phone/Fax

Practice location:
  • Phone: 504-454-1885
  • Fax: 504-454-0925
Mailing address:
  • Phone: 504-454-1885
  • Fax: 504-454-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number024801
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: