Provider Demographics
NPI:1407969637
Name:HIGH PINES UROLOGY PC
Entity Type:Organization
Organization Name:HIGH PINES UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUAN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-367-2832
Mailing Address - Street 1:PO BOX 2619
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-2619
Mailing Address - Country:US
Mailing Address - Phone:928-367-2832
Mailing Address - Fax:928-367-3321
Practice Address - Street 1:300 W WHITE MOUNTAIN BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929
Practice Address - Country:US
Practice Address - Phone:928-367-2832
Practice Address - Fax:928-367-3321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ71818208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty