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General NPI Number Information
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NPI Number | 1952364713
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Entity Type | Individual
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Provider Name | JOHN S KOPPMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 201 HEALTH PARK BLVD SUITE 103
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5796
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Country | US
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Telephone | 904-827-0093
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Fax |
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Provider Business Mailing Address
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Address Line | 201 HEALTH PARK BLVD SUITE 103
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5796
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Country | US
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Telephone | 904-827-0093
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME0093820
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License Number State | FL
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