Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 4926 | FL |
NPI | 1083727242 |
---|---|
Provider Name | Dr. William F Cooper |
First Address | Labelle, FL 33935-5033 |
Second Address | Labelle, FL 33935-5033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 12/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T96023 | (02) | FL |