Provider Demographics
NPI:1588665335
Name:COPELAND, LYNN R
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:R
Last Name:COPELAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130894
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77393-0894
Mailing Address - Country:US
Mailing Address - Phone:936-321-0033
Mailing Address - Fax:936-321-0032
Practice Address - Street 1:111 VISION PARK BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3002
Practice Address - Country:US
Practice Address - Phone:936-321-0033
Practice Address - Fax:936-321-0032
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0464207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115811504Medicaid
TX4573693OtherAETNA
TX811119OtherAETNA
TX35698OtherAMERICAID
TX115811506Medicaid
TX3740661OtherCIGNA
TX84440YOtherBLUE CROSS
TX35698OtherAMERICAID
TX4573693OtherAETNA
TXD24436Medicare UPIN
TX115811506Medicaid