MEDICARE: CHRISTOPHER ROYCE COOPER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician	N2451	TX
2	207Q00000X	Family Medicine Physician	MD20050148	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043228018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER ROYCE COOPER M.D.

Provider Business Mailing Address
First Line	:	10840 TEXAS HEALTH TRL
Second Line	:	STE 250
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6846
Country	:	US
Telephone Number	:	817-306-5630
Fax Number	:	817-306-5631

Provider Business Practice Location Address
First Line	:	9701 HARMON RD STE 141
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-7521
Country	:	US
Telephone Number	:	817-306-5630
Fax Number	:	817-306-5631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	11/19/2019

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