Healthcare Provider Details

I. General information

NPI: 1457576191
Provider Name (Legal Business Name): CHRISTOPHER LEON KOPECKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7922 EWING HALSELL STE. 240
SAN ANTONIO TX
78229
US

IV. Provider business mailing address

7922 EWING HALSELL STE. 240
SAN ANTONIO TX
78229
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-3021
  • Fax: 210-616-0208
Mailing address:
  • Phone: 210-614-3021
  • Fax: 210-616-0208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberF5986
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: