MEDICARE: DR. THOMAS B COOPWOOD M.D.

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	208600000X	Surgery Physician	J7765	TX
2	208600000X	Surgery Physician	DR.0066139	CO

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	86316J	OTHER	TX	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962517086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS B COOPWOOD M.D.

Provider Business Mailing Address
First Line	:	2121 E HARMONY RD UNIT 330
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3403
Country	:	US
Telephone Number	:	970-221-5878
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 E HARMONY RD UNIT 330
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3403
Country	:	US
Telephone Number	:	970-221-5878
Fax Number	:	970-221-3564

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	05/05/2021

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Directions to “ DR. THOMAS B COOPWOOD M.D.” Practice Location

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