Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | N9443 | TX |
Y | 2080P0204X | Pediatric Emergency Doctor | N9443 | TX |
NPI | 1083859698 |
---|---|
Provider Name | Dr. Michael Cronin Cooper |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2008 |
Last Update Date | 11/09/2014 |