Provider Demographics
NPI:1225084627
Name:JEFFREY A. COPOLOFF, PLLC
Entity Type:Organization
Organization Name:JEFFREY A. COPOLOFF, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:COPOLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:623-934-3211
Mailing Address - Street 1:PO BOX 14390
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-4390
Mailing Address - Country:US
Mailing Address - Phone:623-934-3211
Mailing Address - Fax:480-661-3990
Practice Address - Street 1:8415 N PIMA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4480
Practice Address - Country:US
Practice Address - Phone:623-934-3211
Practice Address - Fax:480-661-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0355213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ11178489OtherCAQH
AZ129181Medicaid
AZ6202669OtherGHI
AZ2Z1833OtherHEALTH NET AZ
AZ4496171OtherAETNA
AZ6624646OtherCIGNA
AZAZ0195160OtherBCBS
AZ=========OtherTRICARE
AZ129181Medicaid
AZU18556Medicare UPIN
AZP00346721Medicare PIN
AZ=========OtherTRICARE