Provider Demographics
NPI:1710314679
Name:COPELAND CARE
Entity Type:Organization
Organization Name:COPELAND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-559-4986
Mailing Address - Street 1:2601 N 3RD ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1104
Mailing Address - Country:US
Mailing Address - Phone:602-559-4986
Mailing Address - Fax:480-248-2732
Practice Address - Street 1:2601 N 3RD ST
Practice Address - Street 2:SUITE 213
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1104
Practice Address - Country:US
Practice Address - Phone:602-555-4986
Practice Address - Fax:480-248-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35699208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty