Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 225312 | MA |
N | 111NI0900X | Internist | 225312 | MA |
N | 207R00000X | Internist | 50261 | TN |
N | 111NI0900X | Internist | 50261 | TN |
N | 207RC0000X | Internist - Cardiovascular Disease | 50261 | TN |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 50261 | TN |
NPI | 1134286792 |
---|---|
Provider Name | Dr. Brian Cooper |
First Address | Ooltewah, TN 37363 |
Second Address | Ooltewah, TN 37363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 17/03/2018 |