Provider Demographics
NPI:1174597348
Name:COPELAND, JAMES LLOYD JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LLOYD
Last Name:COPELAND
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 RICHLAND WEST CIR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7932
Mailing Address - Country:US
Mailing Address - Phone:254-537-6200
Mailing Address - Fax:254-537-6201
Practice Address - Street 1:301 RICHLAND WEST CIR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7932
Practice Address - Country:US
Practice Address - Phone:254-537-6200
Practice Address - Fax:254-754-2666
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9402207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N59XOtherMEDICARE & BCBS GROUP #
TX8BM493OtherBCBS
TX084249401OtherMEDICAID GROUP #
TX113992504Medicaid
TX113992501Medicaid
TXC14760Medicare UPIN
TXCO088E957Medicare ID - Type Unspecified
TX113992501Medicaid