Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | A704030 | CA |
N | 207P00000X | Emergency Physician | ME78602 | FL |
NPI | 1003852658 |
---|---|
Provider Name | Edward B Cooper |
First Address | Rancho Mirage, CA 92270-3221 |
Second Address | Rancho Mirage, CA 92270-3221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 09/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003852658 | (05) | CA |
H01581 | (02) | CA |