Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH0003926 | FL |
NPI | 1568542546 |
---|---|
Provider Name | Dr. Stanton Tucker Cooper |
First Address | Palm Bay, FL 32905-3502 |
Second Address | Palm Bay, FL 32905-3502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 13/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
88902Z | MEDICARE (01) | FL |