Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD.013119 | LA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 025131 | GA |
NPI | 1326079799 |
---|---|
Provider Name | Dr. Randolph Leigh Copeland |
First Address | Gallup, NM 87301-1337 |
Second Address | Gallup, NM 87301-1337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 24/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E5728 | (05) | NM |
580218 | (05) | AZ |
H37695 | (02) |