MEDICARE: KARL P. KOERPER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	92-88	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	050051005	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	NM003144	OTHER	NM	BCBS OF NM

General Provider Information

NPI Number	:	1760458459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARL P. KOERPER MD

Provider Business Mailing Address
First Line	:	205 W BOUTZ RD
Second Line	:	BLDG #1
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3262
Country	:	US
Telephone Number	:	575-532-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 W BOUTZ RD
Second Line	:	BLDG #1
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3262
Country	:	US
Telephone Number	:	575-532-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	07/28/2010

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Directions to “ KARL P. KOERPER MD” Practice Location

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