Individual
JACK COPELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 W. ARBOR DR., MC 8892, SAN DIEGO, CA 92103
(619) 543-7777
(619) 543-2652
Mailing address
200 W. ARBOR DR., MC 8892, SAN DIEGO, CA 92103
(619) 543-7777
(619) 543-2652
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
9927
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220997
—
AZ
01
—
330002923
RR MEDICARE
AZ
Enumeration date
02/09/2006
Last updated
05/31/2011
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