Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 07001360A | IN |
Y | 222Z00000X | Podiatrist | 07001360A | IN |
NPI | 1023514395 |
---|---|
Provider Name | John Maxwell Cooper |
First Address | Evansville, IN 47731-3276 |
Second Address | Evansville, IN 47712-6517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2018 |
Last Update Date | 09/11/2021 |