Organization

Christian L Koppel Md Pa

Anesthesiology Physician in Jacksonville, FL(View on Map)

Legal Business Name

Christian L Koppel Md Pa

NPI Number

1457623514

NPI Type

Organization

Enumeration Date

02/06/2012

Specialties

(Taxonomies)

Code

207L00000X

Primary Taxonomy

Yes

Licenses

State

Florida

License Number

ME43414

Contact
Information

Purpose

Mailing
Location

Address

820 PRUDENTIAL DR
820 PRUDENTIAL DR

City

Jacksonville
Jacksonville

State

FL
FL

Postal Code

32207-8210
32207-8210

Country

US
US

Telephone Number

(904) 398-3356
(904) 398-3356

Authorized Official

Name

Christian Koppel

Title or Position

OWNER

Telephone Number

(904) 398-3356

Identifiers

Identifier

15878
00318062A
040168400

Identifier State

Unknown
GA
FL

Identifier Issuer

FLORIDA BLUE CROSS BLUE SHIELD
Unknown
Unknown

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 02/06/2012

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