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NPI Code Detail

MEDICARE: MR. LARRY RAY COPPOCK CCP LP RN

MEDICARE: MR. LARRY RAY COPPOCK CCP LP RN
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
1247200000XOther TechnicianLP7OK
2242T00000XPerfusionistLP7OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1731213482002OTHERBCBS
25993501OTHERAETNA

General Provider Information

NPI Number : 1649334863
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LARRY RAY COPPOCK CCP LP RN
Provider Business Mailing Address
First Line : PO BOX 12815
Second Line : 3601 N MAY AVENUE SUITE C
City : OKLAHOMA CITY
State : OK
Zip : 73157-2815
Country : US
Telephone Number : 405-604-5613
Fax Number : 405-601-3750
Provider Business Practice Location Address
First Line : 3601 N MAY AVE
Second Line : SUITE C
City : OKLAHOMA CITY
State : OK
Zip : 73112-6641
Country : US
Telephone Number : 405-604-5613
Fax Number : 405-601-3750
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2006
Last Update Date : 08/24/2011

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