Basic Information
| Provider Information | |||||||||
| NPI: | 1144439639 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COPELAND | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3122 E MERIDIAN PARK LOOP | ||||||||
| Address2: | |||||||||
| City: | WASILLA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996547255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073579590 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2250 S WOODWORTH LOOP | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PALMER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996457412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077615900 | ||||||||
| FaxNumber: | 9077615975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 04/24/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 02002769A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 7469 | AK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | MDG046 | 01 | AK | MEDICAID MD GROUP # | OTHER | 162616 | 01 | AK | MEDICARE MD GROU # | OTHER |