Provider Demographics
NPI:1649259961
Name:COPELAND, JOHN W (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
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 1:1111 A ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-2324
Mailing Address - Country:US
Mailing Address - Phone:925-778-9110
Mailing Address - Fax:925-778-7233
Practice Address - Street 1:1111 A ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2324
Practice Address - Country:US
Practice Address - Phone:925-778-9110
Practice Address - Fax:925-778-7233
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC26299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00C262990Medicare ID - Type Unspecified
A33089Medicare UPIN