Provider Demographics
NPI:1427097005
Name:COPELAND, MITCHELL THEODORE (DO)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:THEODORE
Last Name:COPELAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2373 G RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-9641
Mailing Address - Country:US
Mailing Address - Phone:970-245-0484
Mailing Address - Fax:970-241-2803
Practice Address - Street 1:2373 G RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-9641
Practice Address - Country:US
Practice Address - Phone:970-245-0484
Practice Address - Fax:970-241-2803
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO36754207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24837326Medicaid
CO24837326Medicaid
H03104Medicare UPIN