Healthcare Provider Details

I. General information

NPI: 1780863860
Provider Name (Legal Business Name): JAMES H. KOPP, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E GREENVILLE ST
ANDERSON SC
29621-5535
US

IV. Provider business mailing address

301 E GREENVILLE ST
ANDERSON SC
29621-5535
US

V. Phone/Fax

Practice location:
  • Phone: 864-224-5689
  • Fax:
Mailing address:
  • Phone: 864-224-5689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number7766
License Number StateSC

VIII. Authorized Official

Name: JAMES H KOPP
Title or Position: OWNER
Credential: MD
Phone: 864-224-5689