Healthcare Provider Details

I. General information

NPI: 1982671905
Provider Name (Legal Business Name): JEFFREY G COPELAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 RICHMOND CENTER CT
SAINT PETERS MO
63376-5973
US

IV. Provider business mailing address

10004 KENNERLY RD STE 283B
SAINT LOUIS MO
63128-2177
US

V. Phone/Fax

Practice location:
  • Phone: 636-397-2001
  • Fax: 636-279-2010
Mailing address:
  • Phone: 314-272-0864
  • Fax: 314-272-0866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberR5D60
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: