Provider Demographics
NPI:1689643900
Name:SOPER, THOMAS HOWARD (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:HOWARD
Last Name:SOPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 IRIS DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4716
Mailing Address - Country:US
Mailing Address - Phone:970-522-7266
Mailing Address - Fax:970-522-4258
Practice Address - Street 1:620 IRIS DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4716
Practice Address - Country:US
Practice Address - Phone:970-522-7266
Practice Address - Fax:970-522-4258
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1361492Medicaid
CO369764YLB8Medicare PIN
CO1361492Medicaid
COCA7288Medicare PIN
G54072Medicare UPIN