Provider Demographics
NPI:1114992823
Name:COPENHAVER, JIM KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:KEVIN
Last Name:COPENHAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 912
Mailing Address - Street 2:HUGGINS HOSPITAL
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894-0912
Mailing Address - Country:US
Mailing Address - Phone:603-569-7575
Mailing Address - Fax:603-569-7564
Practice Address - Street 1:240 S MAIN ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4411
Practice Address - Country:US
Practice Address - Phone:360-257-9403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMDOOO23980207Q00000X
NH16158207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine