Basic Information
| Provider Information | |||||||||
| NPI: | 1215001532 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOPF | ||||||||
| FirstName: | ERIC | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3212 JEFFERSON ST | ||||||||
| Address2: | # 196 | ||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945583436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072558825 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3260 BEARD RD | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945583423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7079275136 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | A66297 | CA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | A66297 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A662970 | 05 | CA | MEDICAID |