Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 325406 | LA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 325406 | LA |
NPI | 1851787444 |
---|---|
Provider Name | Matthew W Cooper |
First Address | Mandeville, LA 70471-3104 |
Second Address | Mandeville, LA 70471-3104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2015 |
Last Update Date | 04/05/2021 |