Provider Demographics
NPI:1629186010
Name:COOPER, WILLIAM H (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
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 1:106 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 1:103 CHICO CT
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-1065
Practice Address - Country:US
Practice Address - Phone:719-852-9400
Practice Address - Fax:719-852-9311
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010342752084N0400X
CO251912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100334010Medicaid
IN151670HMedicare PIN
IN152520JJMedicare PIN
IN228050MMMedicare PIN
130024458Medicare PIN
IN100334010Medicaid
P00356274Medicare PIN
IN254100CMedicare PIN
152380FMedicare PIN
151670HMedicare UPIN
130024457Medicare PIN
151700MMedicare PIN
IN151560I2Medicare PIN