Provider Demographics
NPI:1265554729
Name:COCO, JUSTIN PAUL (DO)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:PAUL
Last Name:COCO
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 1:2480 S DOWNING ST
Mailing Address - Street 2:STE G30
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5889
Mailing Address - Country:US
Mailing Address - Phone:303-777-3277
Mailing Address - Fax:303-698-9713
Practice Address - Street 1:2480 S DOWNING ST
Practice Address - Street 2:STE G30
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5889
Practice Address - Country:US
Practice Address - Phone:303-777-3277
Practice Address - Fax:303-698-9713
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.124705207W00000X
WY9452A207W00000X
CODR.0052276207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41770102Medicaid
CO14770102Medicaid
CO430403YPR3Medicare PIN