MEDICARE: COPPERFIELD MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1336429273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COPPERFIELD MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	7520 CHERRY PARK DR STE A1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-3380
Country	:	US
Telephone Number	:	281-463-7170
Fax Number	:	281-463-7126

Provider Business Practice Location Address
First Line	:	7520 CHERRY PARK DR STE A1
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-3380
Country	:	US
Telephone Number	:	281-463-7170
Fax Number	:	281-463-7126

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SYUZANNA JEREJYAN
Credential	:
Telephone Number	:	281-463-7170

Provider Enumeration Date	:	08/23/2011
Last Update Date	:	08/23/2011

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