Provider Demographics
NPI:1518169572
Name:COPE, AUSTIN R (MD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:R
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 1:1068 E RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4477
Mailing Address - Country:US
Mailing Address - Phone:435-628-4466
Mailing Address - Fax:435-628-3845
Practice Address - Street 1:1068 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4477
Practice Address - Country:US
Practice Address - Phone:435-628-6466
Practice Address - Fax:435-628-3845
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10108379-1205207N00000X
AZR75037390200000X
UT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTCOPEAOtherSWBHC STAFF CODE