Provider Demographics
NPI:1134476120
Name:COPE, JOHN GARRETT (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GARRETT
Last Name:COPE
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 1:5304 CORTADERIA PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-8058
Mailing Address - Country:US
Mailing Address - Phone:505-345-5839
Mailing Address - Fax:
Practice Address - Street 1:5304 CORTADERIA PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-8058
Practice Address - Country:US
Practice Address - Phone:505-345-5839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM70-118208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery