Provider Demographics
NPI:1790769230
Name:COOPER, BRUCE DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DAVID
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:120 BRISTLECONE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2031
Mailing Address - Country:US
Mailing Address - Phone:970-224-5209
Mailing Address - Fax:970-221-7165
Practice Address - Street 1:120 BRISTLECONE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2031
Practice Address - Country:US
Practice Address - Phone:970-224-5209
Practice Address - Fax:970-221-7165
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO24912207Q00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01249127Medicaid
CO01249127Medicaid
COE23302Medicare UPIN