Individual
MARY ALICE COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
204 CARLISLE BLVD NE, ALBUQUERQUE, NM 87106-1317
(505) 266-6522
Mailing address
204 CARLISLE BLVD NE, ALBUQUERQUE, NM 87106-1317
(505) 266-6522
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
92-201
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
E6567
—
NM
Enumeration date
02/12/2007
Last updated
03/07/2023
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