Provider Demographics
NPI:1164635926
Name:COPPOCK, STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:COPPOCK
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 1:1325 MCFARLAND BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3262
Mailing Address - Country:US
Mailing Address - Phone:205-330-5266
Mailing Address - Fax:205-330-9915
Practice Address - Street 1:1325 MCFARLAND BLVD
Practice Address - Street 2:STE 104
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3262
Practice Address - Country:US
Practice Address - Phone:205-348-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29731207Q00000X
ALMD.29731207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine