Individual
DR. JULIAN DE BRUYN KOPS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2065 E 17TH, STE C, IDAHO FALLS, ID 83404
(208) 522-6106
(208) 522-6142
Mailing address
2065 E 17TH, STE C, IDAHO FALLS, ID 83404
(208) 522-6106
(208) 522-6142
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
G25832
CA
207Q00000X
Family Medicine Physician
MD08869
OR
207Q00000X
Family Medicine Physician
Primary
MD3222
ID
Other
Enumeration date
01/04/2006
Last updated
03/22/2010
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