Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 5614879-1205 | UT |
Y | 207QS0010X | Family Doctor - Sports Medicine | 5614879-1205 | UT |
NPI | 1023122611 |
---|---|
Provider Name | Dr. Leslie W Cooper |
First Address | Salt Lake City, UT 84111-1380 |
Second Address | Salt Lake City, UT 84111-1380 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 12/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
735332 | DMBA (01) | UT |
735332 | FAMILY MEDICINE (01) | UT |
D5485 | (05) | UT |
H54841 | (02) | UT |