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General NPI Number Information
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NPI Number | 1407969637
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Entity Type | Organization
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Legal Business Name | HIGH PINES UROLOGY PC
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 W WHITE MOUNTAIN BLVD SUITE C
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City | LAKESIDE
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State | AZ
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Zip | 85929
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Country | US
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Telephone | 928-367-2832
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Fax | 928-367-3321
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Provider Business Mailing Address
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Address Line | PO BOX 2619
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City | LAKESIDE
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State | AZ
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Zip | 85929-2619
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Country | US
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Telephone | 928-367-2832
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Fax | 928-367-3321
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Authorized Official
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Title or Position | OWNER
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Name | DUAN CRAIG COPELAND
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Credential | M.D.
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Telephone | 928-367-2832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 71818
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License Number State | AZ
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