Provider Demographics
NPI:1982688057
Name:COPAS, BRYAN D (PA)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:D
Last Name:COPAS
Suffix:
Gender:M
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:569 32 RD., UNIT 12
Mailing Address - Street 2:MOUNTAIN PEAKS URGENT CARE
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-6095
Mailing Address - Country:US
Mailing Address - Phone:970-523-3544
Mailing Address - Fax:970-434-3422
Practice Address - Street 1:569 32 RD, UNIT 12
Practice Address - Street 2:MOUNTAIN PEAKS URGENT CARE
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-6095
Practice Address - Country:US
Practice Address - Phone:970-523-3544
Practice Address - Fax:970-434-3422
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPA.0002807363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q16562Medicare UPIN
MO000097093Medicare ID - Type Unspecified