Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS7719 | FL |
NPI | 1003803909 |
---|---|
Provider Name | Dr. Christopher Coppola |
First Address | Vero Beach, FL 32960-6500 |
Second Address | Vero Beach, FL 32960-6500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 21/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
267880200 | (05) | FL |
H21098 | (02) | FL |