Provider Demographics
NPI:1215127592
Name:COPELAND, DAVID L (NCTMB)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:COPELAND
Suffix:
Gender:M
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1573
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89446-1573
Mailing Address - Country:US
Mailing Address - Phone:775-623-1123
Mailing Address - Fax:775-623-1126
Practice Address - Street 1:938 W WINNEMUCCA BLVD
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3629
Practice Address - Country:US
Practice Address - Phone:775-623-1123
Practice Address - Fax:775-623-1126
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV340174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV340OtherLIC.NVMT
399213.00OtherNCBTMB