Provider Demographics
NPI:1659301851
Name:COOPER, MINDY A (MD)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:A
Last Name:COOPER
Suffix:
Gender:F
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 4330
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-4330
Mailing Address - Country:US
Mailing Address - Phone:970-926-6340
Mailing Address - Fax:970-926-6348
Practice Address - Street 1:50 BUCK CREEK ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:AVON
Practice Address - State:CO
Practice Address - Zip Code:81620
Practice Address - Country:US
Practice Address - Phone:970-926-6340
Practice Address - Fax:970-926-6348
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29920207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACO1543OtherBLUE SHIELD
WA8146748Medicaid
WA0039589OtherLABOR & INDUSTRY
WAMD3917WOtherALASKA MEDICAID
WAUS1014629OtherAETNA/USHC SPECIALIST
390005685OtherRAILROAD MEDICARE
CO83606076Medicaid
WAUS1014663OtherAETNA/USHC PCP
WA8146748Medicaid
F18945Medicare UPIN
WA0039589OtherLABOR & INDUSTRY