Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 30966 | AL |
Y | 2081P2900X | Pain Medicine | 30966 | AL |
N | 2081S0010X | Sports Medicine | 30966 | AL |
N | 213ES0000X | Sports Medicine | 30966 | AL |
NPI | 1437348711 |
---|---|
Provider Name | Dr. Theodore Kopp |
First Address | Mobile, AL 36695-2676 |
Second Address | Mobile, AL 36695-2676 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2007 |
Last Update Date | 04/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
182198 | (05) | AL |
511-70139 | BCBS OF AL (01) | AL |