Provider Demographics
NPI:1649407685
Name:COPPINGER, BRIAN J (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:COPPINGER
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 1:503 GREENWOOD TRACE DR
Mailing Address - Street 2:
Mailing Address - City:WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-9278
Mailing Address - Country:US
Mailing Address - Phone:317-535-7447
Mailing Address - Fax:
Practice Address - Street 1:503 GREENWOOD TRACE DR
Practice Address - Street 2:
Practice Address - City:WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-9278
Practice Address - Country:US
Practice Address - Phone:317-535-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070785A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine