Individual provider · NPI-1
Larry Ray Coppock, CCP LP RN
Perfusionist · Oklahoma City, OK
NPI number1649334863
StatusActive
Last updated in NPPESAug 24, 2011
Details
- NPI
- 1649334863
- Entity type
- Individual (NPI-1)
- Name
- Mr. Larry Ray Coppock
- Credential
- CCP LP RN
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 21, 2006
- Last updated
- Aug 24, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 242T00000X | Perfusionist | LP7 | OK | Yes |
| 247200000X | Technician, Other | LP7 | OK |
Practice location
3601 N May AveSuite C
Oklahoma City, OK 73112-6641
Phone 405-604-5613 · Fax 405-601-3750
Mailing address
Po Box 128153601 N May Avenue Suite C
Oklahoma City, OK 73157-2815
Phone 405-604-5613 · Fax 405-601-3750
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