Basic Information
| Provider Information | |||||||||
| NPI: | 1154575462 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COPENHAVER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ALVAVADO-COPENHAVER | ||||||||
| OtherFirstName: | DAVID | ||||||||
| OtherMiddleName: | JOSEPH | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4150 V STREET, SUITE 1200 | ||||||||
| Address2: | PSSB | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123053226 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4150 V STREET, SUITE 1220 | ||||||||
| Address2: | PSSB UC DAVIS ANESTHESIOLOGY AND PAIN | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167345042 | ||||||||
| FaxNumber: | 9167342975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2008 | ||||||||
| LastUpdateDate: | 07/27/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | A107352 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.