Provider Demographics
NPI:1912049792
Name:KOPELMAN, JERRY JOSHUA (MD)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:JOSHUA
Last Name:KOPELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1550 S POTOMAC ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5455
Mailing Address - Country:US
Mailing Address - Phone:303-797-7227
Mailing Address - Fax:303-797-8448
Practice Address - Street 1:1550 S POTOMAC ST
Practice Address - Street 2:SUITE 340
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5455
Practice Address - Country:US
Practice Address - Phone:303-797-7227
Practice Address - Fax:303-797-8448
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO17007207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01170075Medicaid
COC803500Medicare PIN
CO01170075Medicaid