Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 29152 | OK |
NPI | 1003182650 |
---|---|
Provider Name | Dr. Emily Jane Cooper |
First Address | Malvern, PA 19355-0746 |
Second Address | Enid, OK 73703-4953 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2012 |
Last Update Date | 19/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200510880B | (05) | OK |
P01533835 | RR MEDICARE (01) | OK |