Basic Information
| Provider Information | |||||||||
| NPI: | 1780188151 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COPELAND | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | KIPPER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8315 KAHALA DR | ||||||||
| Address2: | |||||||||
| City: | DIAMONDHEAD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395254021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6626949267 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 CANAL ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701196535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009358387 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2018 | ||||||||
| LastUpdateDate: | 07/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 321311 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.