Provider Demographics
NPI:1336429273
Name:COPPERFIELD MEDICAL GROUP INC
Entity Type:Organization
Organization Name:COPPERFIELD MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYUZANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEREJYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-463-7170
Mailing Address - Street 1:7520 CHERRY PARK DR STE A1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-3380
Mailing Address - Country:US
Mailing Address - Phone:281-463-7170
Mailing Address - Fax:281-463-7126
Practice Address - Street 1:7520 CHERRY PARK DR STE A1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-3380
Practice Address - Country:US
Practice Address - Phone:281-463-7170
Practice Address - Fax:281-463-7126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty