Provider Demographics
NPI:1760458459
Name:KOERPER, KARL P (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:P
Last Name:KOERPER
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 1:205 W BOUTZ RD
Mailing Address - Street 2:BLDG #1
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3262
Mailing Address - Country:US
Mailing Address - Phone:575-532-7000
Mailing Address - Fax:
Practice Address - Street 1:205 W BOUTZ RD
Practice Address - Street 2:BLDG #1
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3262
Practice Address - Country:US
Practice Address - Phone:575-532-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM92-88207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3015Medicaid
050051005OtherRR MEDICARE
NMNM003144OtherBCBS OF NM