Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 000971 | AZ |
Y | 213ES0103X | Foot & Ankle Surgery | 884 | CO |
NPI | 1053869784 |
---|---|
Provider Name | Candice Cooper |
First Address | Colorado Springs, CO 80920-7583 |
Second Address | Colorado Springs, CO 80920-7583 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2016 |
Last Update Date | 18/11/2021 |