Healthcare Provider Details

I. General information

NPI: 1154528123
Provider Name (Legal Business Name): GREGORY LEE COPELAND DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W HERNDON AVE STE 103
CLOVIS CA
93612-0381
US

IV. Provider business mailing address

255 W HERNDON AVE STE 103
CLOVIS CA
93612-0381
US

V. Phone/Fax

Practice location:
  • Phone: 559-570-0070
  • Fax: 559-570-0059
Mailing address:
  • Phone: 559-570-0070
  • Fax: 559-570-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A10829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: