Provider Demographics
NPI:1285631655
Name:COPELAND, BEVERLY ANNE (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANNE
Last Name:COPELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 CHEVY WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4127
Mailing Address - Country:US
Mailing Address - Phone:541-535-6239
Mailing Address - Fax:541-512-1027
Practice Address - Street 1:730 BIDDLE RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6116
Practice Address - Country:US
Practice Address - Phone:541-535-6239
Practice Address - Fax:541-494-0895
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51322207Q00000X
ORMD179925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G513220Medicaid
CA00G513220Medicaid
CA00G513220Medicaid