Organization
PEACHWOOD MEDICAL GROUP CLOVIS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEE ROY COPELAND M.D. (PRESIDENT)
(559) 324-6200
Entity
Organization
Contact information
Practice address
275 W HERNDON AVE, CLOVIS, CA 93612-0204
(559) 324-6200
(559) 324-6280
Mailing address
275 W HERNDON AVE, CLOVIS, CA 93612-0204
(559) 324-6200
(559) 324-6280
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0066590
—
CA
Enumeration date
11/08/2005
Last updated
03/23/2010
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