Healthcare Provider Details

I. General information

NPI: 1932185196
Provider Name (Legal Business Name): JOHN D COOPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 REDTAIL HAWK RD
ESTES PARK CO
80517-5422
US

IV. Provider business mailing address

203 S ROLLIE AVE
FORT LUPTON CO
80621-1508
US

V. Phone/Fax

Practice location:
  • Phone: 970-586-9230
  • Fax: 970-586-0292
Mailing address:
  • Phone: 303-286-4560
  • Fax: 303-286-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number15554
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: