Provider Demographics
NPI:1528027885
Name:KOPAS, REBECCA M (MD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:M
Last Name:KOPAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:M
Other - Last Name:TOLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 85520
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85754-5520
Mailing Address - Country:US
Mailing Address - Phone:520-777-4470
Mailing Address - Fax:520-777-4470
Practice Address - Street 1:3110 N LLOYD BUSH DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-9071
Practice Address - Country:US
Practice Address - Phone:520-777-4470
Practice Address - Fax:520-777-4470
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31812208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I12788Medicare UPIN
AZZ107532Medicare PIN