Healthcare Provider Details

I. General information

NPI: 1134476120
Provider Name (Legal Business Name): JOHN GARRETT COPE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5304 CORTADERIA PL NE
ALBUQUERQUE NM
87111-8058
US

IV. Provider business mailing address

5304 CORTADERIA PL NW
ALBUQUERQUE NM
87111-8058
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-5839
  • Fax:
Mailing address:
  • Phone: 505-345-5839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number70-118
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: