Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 3000 | AL |
NPI | 1194838557 |
---|---|
Provider Name | Dr. Allan Koplan |
First Address | Birmingham, AL 35209-4249 |
Second Address | Birmingham, AL 35209-4249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T68745 | (02) |