Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 0414858 | KS |
NPI | 1083667885 |
---|---|
Provider Name | David A. Cooley |
First Address | Shawnee Mission, KS 66213-1324 |
Second Address | Shawnee Mission, KS 66213-1324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 28/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C50408 | (02) | KS |