Provider Demographics
NPI:1982688073
Name:COPELAND, JEFFREY RUSSELL (PA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:RUSSELL
Last Name:COPELAND
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:TX
Mailing Address - Zip Code:75839
Mailing Address - Country:US
Mailing Address - Phone:903-683-5781
Mailing Address - Fax:
Practice Address - Street 1:379 FM 2972 W
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-3666
Practice Address - Country:US
Practice Address - Phone:903-683-5781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA 01882363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant