Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | Q9796 | TX |
N | 111NI0900X | Internist | Q9796 | TX |
N | 207RC0200X | Critical Care Medicine | Q9796 | TX |
Y | 207RP1001X | Pulmonary Disease | Q9796 | TX |
NPI | 1063774198 |
---|---|
Provider Name | Samuel Wellington Copeland |
First Address | Victoria, TX 77901-5777 |
Second Address | Victoria, TX 77901-5777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2012 |
Last Update Date | 11/07/2019 |