Provider Demographics
NPI:1043228018
Name:COOPER, CHRISTOPHER ROYCE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROYCE
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10840 TEXAS HEALTH TRL
Mailing Address - Street 2:STE 250
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6846
Mailing Address - Country:US
Mailing Address - Phone:817-306-5630
Mailing Address - Fax:817-306-5631
Practice Address - Street 1:9701 HARMON RD STE 141
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-7521
Practice Address - Country:US
Practice Address - Phone:817-306-5630
Practice Address - Fax:817-306-5631
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2451207QS0010X
NMMD20050148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213337301Medicaid
TX213337302Medicaid
TXP00899432OtherRAILROAD MEDICARE
TX213337302Medicaid