Provider Demographics
NPI:1164461802
Name:COPOLOFF, JEFFREY ALLAN (DPM)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALLAN
Last Name:COPOLOFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 E BELL RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2138
Mailing Address - Country:US
Mailing Address - Phone:480-420-0749
Mailing Address - Fax:480-420-0732
Practice Address - Street 1:3811 E BELL RD
Practice Address - Street 2:SUITE 309
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2138
Practice Address - Country:US
Practice Address - Phone:480-420-0749
Practice Address - Fax:480-420-0732
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0355213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ129181Medicaid
AZ2Z1833OtherHEALTH NET AZ
AZ6202669OtherGHI
AZAZ0195160OtherBCBS
AZ113710768OtherTRICARE
AZ11178489OtherCAQH
AZ6624646OtherCIGNA
AZ4496171OtherAETNA
AZZ78121Medicare PIN
AZ6202669OtherGHI
AZ129181Medicaid
AZ4496171OtherAETNA