Provider Demographics
NPI:1396784518
Name:COPENHAVER, STEVEN CRAIG (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:CRAIG
Last Name:COPENHAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN STE B309
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2540
Mailing Address - Country:US
Mailing Address - Phone:972-566-6996
Mailing Address - Fax:972-566-3107
Practice Address - Street 1:7777 FOREST LN STE B309
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2540
Practice Address - Country:US
Practice Address - Phone:972-566-6996
Practice Address - Fax:972-566-3107
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK24372080P0214X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100757703Medicaid
TX100757703Medicaid