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Individual
MR. LARRY RAY COPPOCK
Active
Individual
MR. LARRY RAY COPPOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCP LP RN
Taxonomy
Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
LP7
OK
247200000X
Other Technician
LP7
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5993501
AETNA
—
01
—
731213482002
BCBS
—
Enumeration date
12/21/2006
Last updated
08/24/2011
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