Provider Demographics
NPI:1194868760
Name:ALFRED J COPPOLA JR MD INC
Entity type:Organization
Organization Name:ALFRED J COPPOLA JR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:J
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:661-323-8121
Mailing Address - Street 1:2634 G ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2814
Mailing Address - Country:US
Mailing Address - Phone:661-323-8121
Mailing Address - Fax:661-322-3547
Practice Address - Street 1:300 OLD RIVER RD STE 200
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9506
Practice Address - Country:US
Practice Address - Phone:661-664-2300
Practice Address - Fax:661-663-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39988207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8735418Medicaid
CABW351AMedicare PIN
CA8735418Medicaid
CAA48049Medicare UPIN