Provider Demographics
NPI:1194133520
Name:KOP, MARY TUDOR SNEED (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:TUDOR SNEED
Last Name:KOP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 GRAPE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4427
Mailing Address - Country:US
Mailing Address - Phone:303-829-6165
Mailing Address - Fax:
Practice Address - Street 1:9094 E MINERAL CIR
Practice Address - Street 2:SUITE 120
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-7200
Practice Address - Country:US
Practice Address - Phone:303-779-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004022363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant