Provider Demographics
NPI:1790758886
Name:COPELAND, LAWRENCE S (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:S
Last Name:COPELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 NTOWN CENTER DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-4000
Mailing Address - Country:US
Mailing Address - Phone:702-485-2791
Mailing Address - Fax:702-485-2812
Practice Address - Street 1:653 NTOWN CENTER DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-4000
Practice Address - Country:US
Practice Address - Phone:702-485-2791
Practice Address - Fax:702-485-2812
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV4809207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2002419Medicaid
NV31488Medicare ID - Type Unspecified
NV2002419Medicaid