Provider Demographics
NPI:1063774198
Name:COPELAND, SAMUEL WELLINGTON (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:WELLINGTON
Last Name:COPELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 HOSPITAL DR STE 402
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5777
Mailing Address - Country:US
Mailing Address - Phone:361-574-1780
Mailing Address - Fax:361-574-1785
Practice Address - Street 1:2705 HOSPITAL DR STE 402
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5777
Practice Address - Country:US
Practice Address - Phone:361-574-1780
Practice Address - Fax:361-574-1785
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9796207R00000X, 207RC0200X, 207RP1001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program