Provider Demographics
NPI:1043307853
Name:COPPLE, NATHAN RANSOM (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:RANSOM
Last Name:COPPLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:670 NINTH STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521
Mailing Address - Country:US
Mailing Address - Phone:707-826-8633
Mailing Address - Fax:707-826-8638
Practice Address - Street 1:1644 CENTRAL AVENUE
Practice Address - Street 2:SUITE F
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519
Practice Address - Country:US
Practice Address - Phone:707-839-3068
Practice Address - Fax:707-839-3827
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG74334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G743340Medicare ID - Type Unspecified
CAF45809Medicare UPIN