Healthcare Provider Details

I. General information

NPI: 1316190473
Provider Name (Legal Business Name): TERRY COPELAND, M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2008
Last Update Date: 11/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W MAIN ST SUITE 205
NORMAN OK
73069-6824
US

IV. Provider business mailing address

1225 W MAIN ST SUITE 205
NORMAN OK
73069-6824
US

V. Phone/Fax

Practice location:
  • Phone: 405-292-5500
  • Fax: 405-292-5505
Mailing address:
  • Phone: 405-292-5500
  • Fax: 405-292-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15713
License Number StateOK

VIII. Authorized Official

Name: TERRY N COPELAND
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 405-292-5500