Provider Demographics
NPI:1154575462
Name:COPENHAVER, DAVID JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
Last Name:COPENHAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:JOSEPH
Other - Last Name:ALVAVADO-COPENHAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4150 V STREET, SUITE 1200
Mailing Address - Street 2:PSSB
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:212-305-3226
Mailing Address - Fax:
Practice Address - Street 1:4150 V STREET, SUITE 1220
Practice Address - Street 2:PSSB UC DAVIS ANESTHESIOLOGY AND PAIN
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-734-5042
Practice Address - Fax:916-734-2975
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107352207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine