Organization
COPPER RIDGE MEDICAL PA
Active
Organization
COPPER RIDGE MEDICAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN NOLEN D.O. (OWNER)
(512) 930-0363
Entity
Organization
Contact information
Practice address
7600 HIGHWAY 29 W, STE #5, GEORGETOWN, TX 78628-6937
(512) 930-0363
(512) 930-0371
Mailing address
7600 HIGHWAY 29 W, STE #5, GEORGETOWN, TX 78628-6937
(512) 930-0363
(512) 930-0371
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
G1494
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G1494
PHYSICIAN STATE LICENSE
TX
Enumeration date
05/01/2008
Last updated
06/17/2009
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