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Individual

LARRY J COPPOLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
5731 GREENDALE RD, SUITE 100, JOHNSTON, IA 50131-1593
(515) 270-1000
(515) 331-6581
Mailing address
5731 GREENDALE RD, SUITE 100, JOHNSTON, IA 50131-1593
(515) 270-1000
(515) 331-6581

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02453
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
I20940052
MEDICARE PTAN
IA
Enumeration date
02/22/2006
Last updated
11/17/2015
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