Provider Demographics
NPI:1366416372
Name:KOPP, JAMES B (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:KOPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:221 3RD ST W
Mailing Address - Street 2:BLDG 1040
Mailing Address - City:RANDOLPH A F B
Mailing Address - State:TX
Mailing Address - Zip Code:78150-4800
Mailing Address - Country:US
Mailing Address - Phone:210-652-3383
Mailing Address - Fax:
Practice Address - Street 1:221 3RD ST W
Practice Address - Street 2:BLDG 1040
Practice Address - City:RANDOLPH A F B
Practice Address - State:TX
Practice Address - Zip Code:78150-4800
Practice Address - Country:US
Practice Address - Phone:210-652-3383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171884301Medicaid
TX171884301Medicaid
TX8D3609Medicare ID - Type Unspecified