Healthcare Provider Details

I. General information

NPI: 1932633484
Provider Name (Legal Business Name): BENJAMIN JOSEPH KOPP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5103 KYLE CENTER DR STE 104
KYLE TX
78640-6164
US

IV. Provider business mailing address

5103 KYLE CENTER DR STE 104
KYLE TX
78640-6164
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-9170
  • Fax: 737-233-5018
Mailing address:
  • Phone: 512-324-9170
  • Fax: 737-233-5018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberS0315
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberS0315
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: