Provider Demographics
NPI:1356409726
Name:COPELAND, DANE D (MD)
Entity type:Individual
Prefix:
First Name:DANE
Middle Name:D
Last Name:COPELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8337 TELEGRAPH RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-4909
Mailing Address - Country:US
Mailing Address - Phone:562-927-2999
Mailing Address - Fax:562-927-2160
Practice Address - Street 1:12400 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4750
Practice Address - Country:US
Practice Address - Phone:562-967-2801
Practice Address - Fax:562-967-2804
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA060056207R00000X
CAAO60056207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA600560Medicaid
CAOOA600560Medicaid
A60056Medicare ID - Type Unspecified