Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 0101056334 | VA |
N | 208000000X | Pediatrician | 0101056334 | VA |
NPI | 1205961364 |
---|---|
Provider Name | Dr. Jeffrey Cooper |
First Address | Arlington, VA 22205-1955 |
Second Address | Arlington, VA 22205-1955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 08/07/2007 |