Provider Demographics
NPI:1730218025
Name:COOPWOOD, THOMAS B I (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:B
Last Name:COOPWOOD
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1601 RIO GRANDE ST STE 340
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1162
Mailing Address - Country:US
Mailing Address - Phone:512-324-8963
Mailing Address - Fax:512-324-8962
Practice Address - Street 1:313 E 12TH ST STE 104
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1955
Practice Address - Country:US
Practice Address - Phone:512-324-8960
Practice Address - Fax:512-324-8962
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0835208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21975Medicare UPIN