Provider Demographics
NPI:1285698241
Name:COPE, DAVID GEORGE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GEORGE
Last Name:COPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5546
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5546
Mailing Address - Country:US
Mailing Address - Phone:801-397-6200
Mailing Address - Fax:801-397-6201
Practice Address - Street 1:185 S 400 E
Practice Address - Street 2:SUITE 100
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4801
Practice Address - Country:US
Practice Address - Phone:801-397-6200
Practice Address - Fax:801-397-6201
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT178399207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000092645Medicare PIN
UT22804OtherPEHP
D87648Medicare UPIN
UTPRA02281OtherMOLINA
005802701Medicare ID - Type Unspecified
UT107006940104OtherIHC
UT141920853DGCOtherEMIA
UT240829OtherALTIUS