Healthcare Provider Details

I. General information

NPI: 1164461802
Provider Name (Legal Business Name): JEFFREY ALLAN COPOLOFF DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 E BELL RD SUITE 309
PHOENIX AZ
85032-2138
US

IV. Provider business mailing address

3811 E BELL RD SUITE 309
PHOENIX AZ
85032-2138
US

V. Phone/Fax

Practice location:
  • Phone: 480-420-0749
  • Fax: 480-420-0732
Mailing address:
  • Phone: 480-420-0749
  • Fax: 480-420-0732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0355
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: