=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053758045
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAN ANTONIO HEART PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2013
-----------------------------------------------------
Last Update Date | 07/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 OAK CENTRE DR STE 270
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-3917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-270-2992
-----------------------------------------------------
Fax | 210-224-7898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 525 OAK CENTRE DR STE 270
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-3917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-270-2992
-----------------------------------------------------
Fax | 210-224-7898
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | DR. GERALD M KOPPES
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 210-270-2992
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | E3343
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------