Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD20050148 | NM |
Y | 207QS0010X | Family Doctor - Sports Medicine | N2451 | TX |
NPI | 1043228018 |
---|---|
Provider Name | Christopher Royce Cooper |
First Address | Fort Worth, TX 76244-6846 |
Second Address | Fort Worth, TX 76177-7521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 19/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
213337301 | (05) | TX |
213337302 | (05) | TX |