Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MD013688E | PA |
NPI | 1639183270 |
---|---|
Provider Name | Dr. David R Cooper |
First Address | Shavertown, PA 18708-9524 |
Second Address | Wilkes Barre, PA 18702-7015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |