Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 2007016662 | MO |
Y | 207N00000X | Dermatologist | CDR.0000100 | CO |
N | 207ND0101X | MOHS-Micrographic Surgeon | 04-34976 | KS |
N | 207ND0101X | MOHS-Micrographic Surgeon | 63895 | GA |
N | 207ND0101X | MOHS-Micrographic Surgeon | CDR.0000100 | CO |
NPI | 1003011404 |
---|---|
Provider Name | Holly Hare Mccoppin |
First Address | Loveland, CO 80539-0731 |
Second Address | Loveland, CO 80537-8817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 12/10/2021 |