Provider Demographics
NPI:1942200506
Name:COPELAND, WILLIAM JACK (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JACK
Last Name:COPELAND
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 1:44215 15TH ST W
Mailing Address - Street 2:STE 315
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4014
Mailing Address - Country:US
Mailing Address - Phone:661-945-4581
Mailing Address - Fax:661-949-5887
Practice Address - Street 1:44215 15TH ST W
Practice Address - Street 2:STE 315
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4014
Practice Address - Country:US
Practice Address - Phone:661-945-4581
Practice Address - Fax:661-949-5887
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41411207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G414110Medicaid
CAWG41411CMedicare PIN
CA00G414110Medicaid