Provider Demographics
NPI:1356310890
Name:COOPER, MAUREEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:A
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:106 BLANCA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2340
Mailing Address - Country:US
Mailing Address - Phone:719-587-1417
Mailing Address - Fax:719-587-6324
Practice Address - Street 1:2115 STUART AVE
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2269
Practice Address - Country:US
Practice Address - Phone:719-589-8153
Practice Address - Fax:719-589-8162
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CODR49357207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000558897OtherANTHEM
CO35057025Medicaid
P00199482Medicare PIN
000000558897OtherANTHEM
CO35057025Medicaid