Healthcare Provider Details

I. General information

NPI: 1043228018
Provider Name (Legal Business Name): CHRISTOPHER ROYCE COOPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 HARMON RD STE 141
FORT WORTH TX
76177-7521
US

IV. Provider business mailing address

10840 TEXAS HEALTH TRL STE 250
FORT WORTH TX
76244-6846
US

V. Phone/Fax

Practice location:
  • Phone: 817-306-5630
  • Fax: 817-306-5631
Mailing address:
  • Phone: 817-306-5630
  • Fax: 817-306-5631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberN2451
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD20050148
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: