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NPI Code Detail

MEDICARE: MR. JEFFREY RUSSELL COPELAND PA

MEDICARE:  MR. JEFFREY RUSSELL COPELAND  PA
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
1363A00000XPhysician AssistantPA 01882TX

General Provider Information

NPI Number : 1982688073
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY RUSSELL COPELAND PA
Provider Business Mailing Address
First Line : PO BOX 665
Second Line :
City : ELKHART
State : TX
Zip : 75839
Country : US
Telephone Number : 903-683-5781
Fax Number :
Provider Business Practice Location Address
First Line : 379 FM 2972 W
Second Line :
City : RUSK
State : TX
Zip : 75785-3666
Country : US
Telephone Number : 903-683-5781
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2005
Last Update Date : 02/18/2015

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Directions to “ MR. JEFFREY RUSSELL COPELAND PA” Practice Location

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