Individual
MR. LARRY RAY COPPOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCP LP RN
Contact information
Practice address
3601 N MAY AVE, SUITE C, OKLAHOMA CITY, OK 73112-6641
(405) 604-5613
(405) 601-3750
Mailing address
PO BOX 12815, 3601 N MAY AVENUE SUITE C, OKLAHOMA CITY, OK 73157-2815
(405) 604-5613
(405) 601-3750
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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