Healthcare Provider Details

I. General information

NPI: 1255323770
Provider Name (Legal Business Name): JOHN COOPER HOWARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER D ONE MEDICAL CENTER DR.
CLARENDON TX
79226-0300
US

IV. Provider business mailing address

PO BOX K ONE MEDICAL CENTER DRIVE
CLARENDON TX
79226-0300
US

V. Phone/Fax

Practice location:
  • Phone: 806-874-3531
  • Fax: 806-874-2244
Mailing address:
  • Phone: 806-874-3531
  • Fax: 806-874-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG-6309
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: