MEDICARE: OLIVER PRESTON COPELAND M.D.

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	2085R0202X	Diagnostic Radiology Physician	D6562	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	300079682	OTHER	TX	TRAVELERS MEDICARE
8	300015119	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10019839	OTHER	TX	AMERIGROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	81R652	OTHER	TX	BCBS
5	82W999	OTHER	TX	BCBS-STMC
6	8DE523	OTHER	TX	BC/BS #
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MDD6562TX	OTHER	TX	WORKER'S COMP
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679578769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVER PRESTON COPELAND M.D.

Provider Business Mailing Address
First Line	:	PO BOX 421209
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77242-1209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 HWY 59 BYPASS
Second Line	:
City	:	WHARTON
State	:	TX
Zip	:	77488
Country	:	US
Telephone Number	:	713-481-3533
Fax Number	:	713-432-0221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/22/2012

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Directions to “ OLIVER PRESTON COPELAND M.D.” Practice Location

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