Healthcare Provider Details

I. General information

NPI: 1144204728
Provider Name (Legal Business Name): MAUREEN K KOOPS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 10/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

V. Phone/Fax

Practice location:
  • Phone: 210-616-8356
  • Fax: 210-616-8383
Mailing address:
  • Phone: 210-616-8356
  • Fax: 210-616-8383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberN7824
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: