Provider Demographics
NPI:1255323770
Name:HOWARD, JOHN COOPER (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:COOPER
Last Name:HOWARD
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:PO BOX K
Mailing Address - Street 2:ONE MEDICAL CENTER DRIVE
Mailing Address - City:CLARENDON
Mailing Address - State:TX
Mailing Address - Zip Code:79226-0300
Mailing Address - Country:US
Mailing Address - Phone:806-874-3531
Mailing Address - Fax:806-874-2244
Practice Address - Street 1:1 MEDICAL CENTER D
Practice Address - Street 2:ONE MEDICAL CENTER DR.
Practice Address - City:CLARENDON
Practice Address - State:TX
Practice Address - Zip Code:79226-0300
Practice Address - Country:US
Practice Address - Phone:806-874-3531
Practice Address - Fax:806-874-2244
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG-6309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123790106Medicaid
TX115488101OtherFIRSTCARE
TX121515OtherSUPERIOR
TX84130Y / 0044EBOtherBLUE CROSS BLUE SHIELD
TX115488101OtherFIRSTCARE
TX00854JMedicare ID - Type UnspecifiedPART B